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Sample records for osteofibroso flexor das

  1. Hip flexor strain - aftercare

    MedlinePlus

    ... flexor - aftercare; Hip flexor injury - aftercare; Hip flexor tear - aftercare; Iliopsoas strain - aftercare; Strained iliopsoas muscle - aftercare; Torn iliopsoas muscle - aftercare; Psoas strain - aftercare

  2. Rheumatoid flexor tenosynovitis and rupture.

    PubMed

    Ferlic, D C

    1996-08-01

    Rheumatoid flexor tenosynovitis at the wrist can cause locking, limitation of motion, nerve compression, and rupture of tendons. To prevent and treat these conditions, a flexor tenosynovectomy, combined with nerve decompression and tendon reconstruction as indicated, is necessary. If tendons are ruptured, the flexor pollicis longus and profundus to the index finger are most commonly affected. On the fingers flexor tenosynovitis can also cause locking, decrease in range of motion and rupture tendons. Flexor tenosynovitis of the fingers should be treated with decompression of the tendons health with preservation of the pulley system.

  3. Flexor tendon injuries. Part 5. Flexor tenolysis, rehabilitation and results.

    PubMed

    Strickland, J W

    1987-03-01

    In this five-part series, we have attempted to review our current understanding of flexor tendon anatomy, physiology, biomechanics, healing and adhesion formation around a repaired tendon. The methods of acute flexor tendon repair, conventional free tendon grafting, staged flexor tendon reconstruction and pulley restoration have been discussed as well as flexor tenolysis, rehabilitation and results. From these articles it may be seen that flexor tendon surgery is a complex and difficult art which requires a thorough appreciation of the normal flexor tendon system, the exact status of that system following injury and a strong understanding of the techniques which may be best utilized to restore flexor tendon function. The procedures described require both technical skill and experience and postoperative therapy programs must be carefully instituted based on the unique status of each patient. With the important advances occurring in many areas of flexor tendon surgery, it is realistic to believe that in the near future the techniques described in these articles may be substantially altered and modified. Results will continue to improve until the patient and surgeon can realistically expect to return most digits to nearly full function after flexor tendon interruption.

  4. Closed flexor tendon ruptures.

    PubMed

    Netscher, David T; Badal, Justin J

    2014-11-01

    We review different causes, diagnoses, and treatment options of closed flexor tendon disruptions in the hand. A classification of closed tendon ruptures based on their mechanism includes traumatic tendon avulsion, spontaneous midsubstance rupture, attrition rupture, infiltrative tenosynovial rupture, and iatrogenic. Certain conditions result in tendon disruption inflicted by more than 1 of these etiologies. In rheumatoid arthritis, tendon rupture may result from attrition on an exposed rough surface, proliferative tenosynovial tendon infiltration, or steroid use. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Flexor Pollicis Longus Tendoscopy.

    PubMed

    Lui, Tun Hing

    2017-02-01

    The deep palmar spaces of the hand include the midpalmar space, the hypothenar space, the thenar space, space of Parona, and the interdigital web spaces. There are various communications between different spaces. These communications are of clinical importance in explaining the spread of inflammatory, infectious, and even neoplasic processes that involve this region. Surgical incision and drainage of all potentially communicating spaces and compartments is mandatory in deep hand infections. The purpose of this technical note is to describe the minimally invasive approach of endoscopic drainage and debridement of the flexor pollicis longus tendon sheath, radial bursa, and thenar space.

  6. Pyogenic flexor tenosynovitis in children.

    PubMed

    Luria, Shai; Haze, Amir

    2011-08-01

    Pyogenic flexor tenosynovitis is an uncommon, emergent hand infection. The literature lacks any description of the disease and the variability of its manifestations in young children. We describe 3 cases. Two cases were diagnosed and treated promptly, and the third presented late, with atypical clinical signs, causing a delay in his diagnosis and treatment and stressing the caution to be taken with the evaluation of these children with signs of hand infection.

  7. Pyogenic flexor tenosynovitis leading to an amputation.

    PubMed

    Evgeniou, Evgenios; Iyer, Srinivasan

    2012-08-24

    Flexor tenosynovitis is an aggressive closed-space infection of the digital flexor tendon sheaths of the hand. We present a case of pyogenic flexor tenosynovitis in an immunocompromised patient and discuss the importance of early diagnosis and referral to a specialist hand surgery unit. A 61-year-old man visited his general practitioner because of swelling and tenderness of his left index finger. The patient was discharged on oral antibiotics but returned 4 days after because of deterioration of his symptoms and was referred to a plastic surgery unit. A diagnosis of flexor tenosynovitis was made and the patient required multiple debridements in theatre, resulting in the amputation of the infected finger. Pyogenic flexor tenosynovitis is a relatively common but often misdiagnosed hand infection. Patients with suspected flexor tenosynovitis should be referred and treated early to avoid significant morbidity, especially when risk factors for poor prognosis are present.

  8. [Flexor pulleys of the fingers. Anatomy, biomechanics, reconstruction].

    PubMed

    Hahn, P; Lanz, U

    1996-09-01

    Primary or secondary flexor tendon surgery occasionally leads to damaged flexor pulleys. Insufficient pulley reconstruction causes loss of finger function by bow stringing of the flexor tendon. This paper reviews the anatomy and biomechanics of the flexor pulley system. Different techniques of reconstruction are discussed.

  9. Pyogenic Flexor Tenosynovitis Caused by Shewanella algae.

    PubMed

    Fluke, Erin C; Carayannopoulos, Nikoletta L; Lindsey, Ronald W

    2016-07-01

    Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum. Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections and necrosis. In this case, S. algae caused complicated flexor tenosynovitis requiring open surgical irrigation and debridement. Flexor tenosynovitis caused by S. algae rapidly presented with all 4 Kanavel cardinal signs as well as subcutaneous purulence, ischemia, and necrosis, thus meeting the requirements for Pang et al group III classification of worst prognosis. Because of its rarity and virulence, S. algae should always be considered in cases of flexor tenosynovitis associated with traumatic water exposure to treat and minimize morbidity appropriately.

  10. Flexor tendon repair in zone III.

    PubMed

    Al-Qattan, Mohammad M

    2011-01-01

    There is a paucity of the literature on the outcome of zone III flexor tendon injuries. In this paper, we report on the results of zone III flexor tendon repair in 35 consecutive adult patients with clean cut lacerations of both flexor tendons in 42 fingers. There were 25 men and 10 women with an average age of 32 years. Repair of both flexor tendons was performed using 'figure of eight' core sutures and a continuous epitendinous suture. Postoperatively, an immediate active range of motion protocol was applied to ensure full active extension of the interphalangeal joints. The results were assessed using the Strickland-Glogovac grading system. There were no ruptures. One patient with two injured fingers developed complex regional pain syndrome and the final outcome was fair in both fingers. In the remaining 34 patients (40 fingers), 33 patients (38 fingers) had an excellent outcome and the remaining patient (two fingers) had a good outcome.

  11. Atraumatic Flexor tendon retrieval- a simple method

    PubMed Central

    2013-01-01

    Background Zone 2 flexor tendon injuries still represent a challenging problem to hand surgeons despite the well developed surgical techniques and suture materials. Meticulous surgical repair with atraumatic handling of the severed tendon stumps and minimal damage to the tendon sheath are particularly important to prevent postoperative adhesions and ruptures in this area. In zone 2 flexor tendon injuries proximal to the vinculas, the cut ends of the flexor tendons retract to the palm with muscle contraction. To retrieve the severed proximal flexor tendon under tendon sheath and pulley system is very difficult without damaging these structures. Many techniques are described in the literature for the delivery of the retracted proximal tendon stump to the repair site. Methods In this report we would like to present a simple and relatively atraumatic technique that facilitates passing of the retracted flexor tendon through the pulleys in zone 2. We sutured the proximal tendon stump at the distal palmar crease with 3–0 polypropylene suture and used a 14 gauge plastic feeding tube, acting like a conduit for the passage of straightened needle to the finger. Results We have used this technique 21 times without any complication in our clinic. We have not seen any suture breakage during the passage or needle breakage due to the bending of the needle. Conclusions We have found this technique is very simple and very effective in retrieving the retracted tendon stump without causing undue damage to the tendon stump or tendon sheath. PMID:24040913

  12. [Primary flexor tendons repair in zone 2].

    PubMed

    Bellemère, P; Ardouin, L

    2014-12-01

    Primary flexor tendon repair is still challenging even in the most experienced hands. With atraumatic surgery, the goal is to suture the tendon in a way that it will be strong enough to allow for tendon gliding without the risk of rupture or adhesions during the 12 weeks needed for the tendon to heal. After reviewing the zone 2 anatomy, the authors describe the state of art for flexor tendon repair along with their personal preferences. Although suture methods and postoperative rehabilitation programs are not universal, most specialized teams now use multistrand suturing techniques with at least 4 stands along with protected and controlled early active mobilization. Although the published rates of failure of the repair or postoperative adhesions with stiffness have decreased, these complications are still a concern. They will continue to pose a challenge for scientists performing research into the mechanics and biology of flexor tendon repairs, especially in zone 2.

  13. Flexor Tendon Pulley Injuries in Rock Climbers.

    PubMed

    King, Elizabeth A; Lien, John R

    2017-02-01

    Closed pulley ruptures are rare in the general population but occur more frequently in rock climbers due to biomechanical demands on the hand. Injuries present with pain and swelling over the affected pulley, and patients may feel or hear a pop at the time of injury. Sequential pulley ruptures are required for clinical bowstringing of the flexor tendons. Ultrasound confirms diagnosis of pulley rupture and evaluates degree of displacement of the flexor tendons. Isolated pulley ruptures frequently are treated conservatively with early functional rehabilitation. Sequential pulley ruptures require surgical reconstruction. Most climbers are able to return to their previous activity level.

  14. Acute flexor tendon repairs in zone II.

    PubMed

    Coats, Robert W; Echevarría-Oré, Julio C; Mass, Daniel P

    2005-05-01

    Flexor tendon repair in zone II is still a technically demanding procedure, but the outcomes have become more predictable and satisfying. Of keystone importance for obtaining the goals of normal strength and gliding of repaired flexor tendons are an atraumatic surgical technique, an appropriate suture material, a competent pulley system, and the use of early motion rehabilitation protocols. The overall goal of hand and finger function also implies timely addressing of neurovascular injuries. New devices such as the TenoFix (Ortheon Medical; Winter Park, Florida) have shown adequate strength in the laboratory but are bulky and untested for work of flexion. Insufficient clinical data and high cost may prevent widespread use.

  15. [Flexor tendon pulley system: anatomy, pathology, treatment].

    PubMed

    Moutet, F

    2003-02-01

    Flexor tendon pulley has been very early noticed and described. Terminology usually accepted recognizes 6 arcifom pulleys (A0 to A5) and 3 cruciform pulleys (C1 to C3). Anatomy and physiology of this flexor tendon gliding and reflection system at the level of the digital sheet are exposed. The integrity necessity of this system became obvious regarding the flexor tendons repair. Four main pathologies may be concerned: the trigger finger congenital or progressive, due to a chondroid metaplasia of the A1 pulley; tenosynovial ganglions arising at the weak point between A1 and A2 pulley; lesions of the flexor tendon sheet during traumatic lacerations or surgical repairs; quite experimental lesions creating isolated ruptures of one or several pulleys which occur during sport practice, especially high level rock climbing. The repair techniques are exposed to allow to graduate and hierarchy the reparation technique regarding the pathology. A2 and A4 repair is always indicated. The best reconstruction material is an extensor retinaculum graft. But its poor surface available often draws to use conventional palmaris longus free graft.

  16. Spontaneous "spaghetti" flexor tendon ruptures in the rheumatoid wrist.

    PubMed

    Hashizume, Hiroyuki; Nishida, Keiichiro; Fujiwara, Kazuo; Inoue, Hajime

    2004-01-01

    A 54-year-old woman who had been treated for rheumatoid arthritis for 12 years developed spontaneous multiple flexor tendon ruptures during a 5-month period. Radiography revealed volar subluxation of the lunate bone. Surgery was performed 5 months after the first onset of tendon rupture. All eight flexors, except the flexor pollicis longus tendons, had ruptured, and the damage resembled spaghetti. Four flexor digitorum profundus tendons were reconstructed by bridge graft using their respective sublimis tendons. Wrist joint fusion and tenolysis were performed 3 months after the first operation. Each finger achieved a good range of motion 2 years and 6 months after the second operation.

  17. Acellular flexor tendon allografts: a new horizon for tendon reconstruction.

    PubMed

    Drake, David B; Tilt, Alexandra C; DeGeorge, Brent R

    2013-12-01

    Flexor tendon injuries continue to pose a significant challenge to the hand surgeon. In particular, chronic tendon ruptures with adhesions of the tendons and sheath, damage or loss of the intrasynovial flexor tendons in zone II, and combined soft tissue and bone injuries present especially difficult problems for restoring satisfactory digital function. This challenge in flexor tendon reconstruction has motivated hand surgeons to explore and develop novel solutions for nearly a century. Recent advances and techniques in processing and decellularizing allograft human flexor tendon constructs may prove to be a new horizon for tendon reconstruction. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. Flexor tendon tissue engineering: acellularized and reseeded tendon constructs.

    PubMed

    Chong, Alphonsus K S; Riboh, Jonathan; Smith, R Lane; Lindsey, Derek P; Pham, Hung M; Chang, James

    2009-06-01

    Tissue engineering of flexor tendons requires scaffolds with adequate strength and biocompatibility. The biomechanical properties of acellularized and reseeded flexor tendon scaffolds are unknown. Acellularized tendons and reseeded constructs were tested to determine whether the treatment process had altered their biomechanical properties. Rabbit flexor tendons were acellularized using a freeze-thaw cycle followed by trypsin and Triton-X treatment. Complete acellularization of the tendon samples was confirmed by histology and by attempting to obtain viable cells by trypsin treatment of acellularized tendon. Reseeded constructs were obtained by incubating acellularized tendons in a tenocyte suspension. Tensile testing was performed to compare the ultimate tensile stress and elastic modulus of acellularized tendons and reseeded flexor tendon constructs to control flexor tendons. The treatment protocol successfully acellularized flexor tendons. No cells were seen within the tendon on histologic assessment, and no viable cells could be obtained from acellularized tendon. Acellularized tendon was successfully reseeded with tenocytes, although cell adhesion was limited to the surface of the tendon scaffold. Tensile testing showed that acellularized tendon had the same ultimate stress and elastic modulus as normal tendons. Reseeded tendons had the same elastic modulus as normal tendons, but hind-paw tendon constructs showed a decrease in ultimate stress compared with normal tendons (50.09 MPa versus 66.01 MPa, p = 0.026). Acellularized flexor tendons are a potential high-strength scaffold for flexor tendon tissue engineering. This approach of acellularization and reseeding of flexor tendons may provide additional intrasynovial graft material for hand reconstruction.

  19. Rupture of all digital flexors following Colles' fracture.

    PubMed

    Iyer, Srinivasan; Basu, Indraneil; Kaba, Rahim; Pabari, Amit

    2012-10-01

    Flexor tendon rupture following a Colles' fracture is a rare complication with only a handful of cases reported since the initial report in 1932. We present a case in which all digital flexor tendons ruptured within 6 months of a Colles' fracture. Previous reported cases have demonstrated rupture of either the radial or ulnar digital flexors but this case is the first in which all the digital flexors have been involved. This case report highlights the clinical implications of this rare occurrence and stresses the importance of accurate reduction and thorough clinical examination following bony injuries to the wrist.

  20. Incidence and morphology of accessory heads of flexor pollicis longus and flexor digitorum profundus (Gantzer's muscles)

    PubMed Central

    JONES, M.; ABRAHAMS, P. H.; SAÑUDO, J. R.; CAMPILLO, M.

    1997-01-01

    In 1813 Gantzer described 2 accessory muscles in the human forearm which bear his name (Wood, 1868; Macalister, 1875; Testut, 1884; Le Double, 1897). The more frequent of the 2 accessory muscles or ‘accessorius ad pollicem’ was found to arise from the coronoid process of the ulna, coursing distally to attach into the flexor pollicis longus muscle (flexor pollicis longus accessory head, FPLah). The less frequently observed or ‘accessorius ad flexorem profundum digitorum’ was again found to arise from the coronoid process and course to join into the flexor digitorum profundus (flexor digitorum profundus accessory head, FDPah). Since their initial description, they have been examined in further detail by a number of authors (Wood, 1868; Macalister, 1875; Le Double, 1897; Dykes & Anson, 1944; Mangini, 1960; Malhotra et al. 1982; Dellon & McKinnon, 1987; Kida, 1988). These studies, most of them focusing on the FPLah, all show different results of prevalence, origin, insertion, relations and nerve supply. We undertook this study with the aim of providing a more accurate account of the detailed morphology of both accessory muscles because of the above-mentioned inconsistent anatomical descriptions and the lack of information as to important aspects such as vascular supply, morphology (shape and length) and the coexistence of both accessory heads. PMID:9419002

  1. Tendon ruptures: mallet, flexor digitorum profundus.

    PubMed

    Yeh, Peter C; Shin, Steven S

    2012-08-01

    Mallet injuries are the most common closed tendon injury in the athlete. Flexor digitorum profundus ruptures are rare in baseball, but are common injuries in contact sports. The diagnosis for each condition is based on clinical examination, although radiographs should be evaluated for a possible bony component. Treatment for mallet injury depends on the athlete's goals of competition and understanding of the consequences of any treatment chosen. Gripping, throwing, and catching would be restricted or impossible with the injured finger immobilized. Treatment of FDP ruptures is almost always surgical and requires reattachment of the torn tendon to the distal phalanx.

  2. Fibromatosis of the flexor pollicus longus tendon

    PubMed Central

    Damkat-Thomas, L; Black, CE; Herbert, K

    2010-01-01

    An unusual case of fibromatosis of the dominant left flexor pollicus longus (FPL) in a thirteen year old schoolboy. Initially presenting with pain in the thenar eminence and difficulty flexing the metacarpal phalangeal joint (MPJ), other symptoms include locking, triggering and difficulty writing. MRI showed a 4cm segment of thickened abnormal tendon. Intra-operatively three 1cm nodules were excised from the FPL while preserving the tendon. Histopathology reported the nodules as fibromatosis. A literature search revealed that this has not previously been reported although symptomatic tendon sheath fibromas have. Our patient achieved a good result following surgical intervention and the two year review has shown no complications. PMID:24946359

  3. Should we think about wrist extensor after flexor tendon repair?

    PubMed Central

    Ferreira, Aline M; Tanaka, Denise M; Barbosa, Rafael I; Marcolino, Alexandre M; Elui, Valeria MC; Mazzer, Nilton

    2013-01-01

    Objective: To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair. Design: Cross-sectional clinical measurement study. Setting: Laboratory for biomechanics and rehabilitation. Subjects: A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age. Intervention: Volunteers performed an isometric standardized gripping task. Main measures: We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis. Results: Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated. Conclusion: Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary. PMID:26770674

  4. Bilateral flexor tendon contracture following onychectomy in 2 cats.

    PubMed

    Cooper, Maureen A; Laverty, Peter H; Soiderer, Emily E

    2005-03-01

    Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes.

  5. Bilateral flexor tendon contracture following onychectomy in 2 cats

    PubMed Central

    2005-01-01

    Abstract Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes. PMID:15884646

  6. Stenosing flexor tenosynovitis following a rattlesnake bite.

    PubMed

    Lee, Lydia; Yao, Jeffrey

    2010-07-13

    Snakebite victims have been described previously in orthopedic literature in regard to complications such as compartment syndrome and carpal tunnel syndrome. We introduce a previously unreported complication of stenosing flexor tenosynovitis in a patient bitten by a rattlesnake. After being bitten in her right forearm, the patient experienced mild systemic symptoms of fever and nausea and was assessed at an outside hospital, where it was determined that she did not suffer from envenomation and therefore did not require antivenin therapy. She presented to our institution 1 week later with signs and symptoms of acute, new-onset right thumb flexor tenosynovitis, with pain and tenderness at the level of the A1 pulley of the thumb, with intermittent triggering. She also presented the following week with ipsilateral carpal tunnel syndrome. The patient reported no such symptoms prior to the snakebite. Given the recent development of these conditions after her snakebite, in addition to her history of endocrine disorders, we believe that our patient suffered from envenomation that led to these complications. Nonoperative measures including splinting and steroid injections were taken, with mixed results, and surgical intervention was necessary. While the proper management of snakebites is controversial, especially in regard to the administration of antivenin, we believe our patient would have benefitted from immediate evaluation and consideration for antivenin. Copyright 2010, SLACK Incorporated.

  7. The effects of eye coordination during deep cervical flexor training on the thickness of the cervical flexors

    PubMed Central

    Moon, Hyun-Ju; Goo, Bong-Oh; Kwon, Hae-Yeon; Jang, Jun-Hyeok

    2015-01-01

    [Purpose] The purpose of this study was to identify changes in the thicknesses of the cervical flexors according to eye coordination during deep cervical flexor training. [Subjects and Methods] Twenty normal adults were randomly selected, and during their deep cervical flexor training and eye tracking, the thicknesses of the longus colli and the sternocleidomastoid were measured using ultrasonic waves. [Results] The thickness of the longus colli statistically significantly increased when deep cervical flexor training and eye coordination were performed simultaneously. However, the thickness of the sternocleidomastoid did not show statistically significant differences according to eye coordination. [Conclusion] Eye coordination during deep cervical flexor training is likely to increase the thickness of the longus colli selectively. PMID:26834355

  8. Endoscopic Adhesiolysis of Flexor Hallucis Longus Muscle.

    PubMed

    Lui, Tun Hing

    2017-04-01

    Adhesion of the flexor hallucis longus (FHL) muscle to the distal tibia can occur after distal tibial fracture, distal fibular fracture, low tibial osteotomy, soft-tissue injury at the posterior ankle, subclinical compartment syndrome of the distal deep posterior compartment of the leg, or Volkmann contracture after deep posterior compartment syndrome of the leg. The purpose of this Technical Note is to report the endoscopic approach of FHL muscle adhesiolysis. It is indicated in patients with symptomatic adhesion of the FHL muscle and contraindicated if there is entrapment of the FHL muscle or tendon in the fracture callus or if there is extensive fibrosis and contracture of the FHL muscle as a result of Volkmann contracture after deep posterior compartment syndrome of the leg.

  9. An Overview of the Management of Flexor Tendon Injuries

    PubMed Central

    Griffin, M; Hindocha, S; Jordan, D; Saleh, M; Khan, W

    2012-01-01

    Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines. PMID:22431948

  10. Advances in the healing of flexor tendon injuries.

    PubMed

    Sammer, Douglas M; Chung, Kevin C

    2014-05-01

    The intrasynovial flexor tendons of the hand are critical for normal hand function. Injury to these tendons can result in absent finger flexion, and a subsequent loss of overall hand function. The surgical techniques used to repair these tendons have improved in the past few decades, as have the postoperative rehabilitation protocols. In spite of these advances, intrasynovial flexor tendon repairs continue to be plagued by postoperative scar formation, which limits tendon gliding and prevents a full functional recovery. This paper describes the current challenges of flexor tendon repair, and evaluates the most recent advances and strategies for achieving an excellent functional outcome. © 2014 by the Wound Healing Society.

  11. Vascularized dorsal digital fascial flap improves flexor tendon repairs.

    PubMed

    Sun, L-Q; Zhao, G; Gao, S-H; Chen, C

    2014-09-01

    We report a new method of flexor tendon repair in zone II using a standard modified Kessler technique combined with a vascularized dorsal fascial flap from the finger pedicled on a dorsal cutaneous branch of the proper digital artery, which is placed as a mechanical barrier between the flexor digitorum superficialis and profundus tendons. The functional outcomes of 14 patients (Group A) with flexor tendon repairs in zone II by this new technique were compared with those of 32 patients (Group B) with flexor tendon repairs in zone II using a standard modified Kessler technique only. Patients in Group A had a higher proportion of excellent results (on the modified Strickland system) and more movement in the distal interphalangeal joint than the patients in Group B.

  12. Flexor Tendon Ruptures After Distal Scaphoid Excision for Scaphotrapeziotrapezoid Osteoarthritis.

    PubMed

    Deren, Matthew E; Mitchell, Charles H; Weiss, Arnold-Peter C

    2017-09-01

    Distal scaphoid excision is one treatment option for osteoarthritis of the scaphotrapeziotrapezoid (STT) joint following failure of conservative measures. Potential complications of this procedure include injury to the carpal ligaments, cartilage, and radial artery. A single case was identified by the senior author, and the medical record was reviewed for surgical notes, progress notes, and radiographs. A 68-year-old male sustained ruptures of the flexor digitorum superficialis (FDS) and flexor digitorum profundus to the index finger 3 years following a distal scaphoid excision for symptomatic STT osteoarthritis. He required a flexor tendon reconstruction using the remaining FDS tendon for graft incorporated with a Pulvertaft weave. His midcarpal pain continued after recovery of his index finger function, eventually requiring a 4-corner fusion of the wrist. Flexor tendon rupture is a previously unreported complication of distal scaphoid excision for STT arthritis.

  13. Zone III flexor tendon injuries - A proposed modification to rehabilitation.

    PubMed

    Chinchalkar, Shrikant J; Pipicelli, Joey G; Agur, Anne; Athwal, George S

    2015-01-01

    In this manuscript, these authors have utilized years of clinical experience to suggest rehabilitation modifications for Zone III flexor tendon injuries. - VictoriaPriganc, PhD, OTR, CHT, CLT, Practice Forum Editor.

  14. MRI in flexor tendon rupture after collagenase injection.

    PubMed

    Khurana, Shruti; Wadhwa, Vibhor; Chhabra, Avneesh; Amirlak, Bardia

    2017-02-01

    Flexor tendon rupture is an unusual complication following collagenase injection to relieve contractures. These patients require a close follow-up and in the event of tendon rupture, a decision has to be made whether to repair the tendon or manage the complication conservatively. The authors report the utility of MRI in the prognostication and management of a patient with Dupuytren's contracture, who underwent collagenase injection and subsequently developed flexor digitorum profundus tendon rupture.

  15. [Tenolysis of the flexor tendons in the hand].

    PubMed

    Pillukat, T; Fuhrmann, R; Windolf, J; van Schoonhoven, J

    2015-10-01

    Properly gliding flexor tendons is mandatory for the normal functioning of the finger and thumb. Any damage to tendons, tendon sheath or adjacent tissue can lead to the formation of adhesions that inhibit the normal gliding function. If adhesions limit the digital function and adequate hand therapy does not provide further progress, then surgical intervention should be considered. The authors' strategy and treatment algorithm for flexor tenolysis are presented in the context of the current literature. There is no absolute indication for flexor tenolysis. The decision should be made in a motivated patient who has access to adequate postoperative hand therapy. It should be based on healed fractures and osteotomies, mature soft tissue coverage, intact tendons and gliding tissues, and a full range of passive flexion, and preferably extension of the affected joints. The principle of flexor tenolysis is the consequent resection of all adhesive tissue around the tendon inside and outside the tendon sheath, with preservation of as many pulley sections as possible. Therefore, extensive approaches are frequently necessary. Arthrolysis and the resolution of unfavorable scars, the resection of scarred lumbricals, and pulley reconstruction are additional procedures that are frequently performed. In the literature, improvement in the range of motion is between 59 and 84 %. Good and excellent functional results are reported in 60-80 % of the cases. Nevertheless, in selected cases, functional deterioration occurs. Flexor tendon ruptures after tenolysis were observed in 0-8 % of the patients. With regard to complications such as secondary tendon ruptures, loss of pulleys, and scar formation, flexor tenolysis is part of a reconstructive ladder that includes further procedures. In the case of failure or complications, salvage procedures such as arthrodesis, amputation, and ray resection or staged flexor tendon reconstruction including tendon grafting are recommended. After

  16. Nomenclatural review of long digital forelimb flexors in carnivores.

    PubMed

    Spoor, C F; Badoux, D M

    1986-12-01

    A hitherto-unknown atavistic muscle in the dog initiated a review of the literature on the homologies and nomenclature of the forelimb flexors in carnivores and man. A consequence is that we recommend a revision of the nomenclature in the Nomina Anatomica Veterinaria (Ithaca, New York, 1983) so that it is in agreement with the Nomina Anatomica (Wilkins, Baltimore, 1983). This revision mainly consists of the incorporation of the terms M. palmaris longus and Mm. flexores breves manus.

  17. The flexor tendon pulley system and rock climbing.

    PubMed

    Crowley, Timothy P

    2012-06-01

    Rock climbing has increased in popularity over the past two decades. Closed traumatic rupture of the finger flexor tendon pulleys is rare among the general population but is seen much more commonly in rock climbers. This article reviews the anatomy and biomechanics of the finger flexor tendon pulleys, how they may be injured in rock climbing and how these injuries are best diagnosed and managed.

  18. Arthroscopic Synovectomy for Zone 2 Flexor Hallucis Longus Tenosynovitis.

    PubMed

    Lui, Tun Hing

    2015-10-01

    Tenosynovitis of the flexor hallucis longus tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. It mostly involves the portion of the tendon behind the ankle joint. However, the portion of the tendon under the sustentaculum tali can also be involved. Open synovectomy requires extensive dissection. We report the technique of arthroscopic synovectomy of the deep portion of the flexor hallucis longus.

  19. Spontaneous Flexor Tendon Rupture Due to Atraumatic Chronic Carpal Instability

    PubMed Central

    Miranda, B. H.; Cerovac, S.

    2014-01-01

    Background Spontaneous flexor tendon rupture is considered to be invariably associated with previous hand/wrist injury or systemic disease such as rheumatoid arthritis. Case Description A 54-year-old man presented with a 4-month history of mild ulnar wrist pain and spontaneous left little finger flexion loss in the absence of distant/recent trauma and systemic arthropathy. Surgical exploration confirmed a zone IV left little finger flexor digitorum profundus (FDP5) attritional rupture (100%), ring finger flexor digitorum profundus (FDP4) attenuation (40%) and a disrupted lunotriquetral ligament and volar-ulnar wrist capsule. Volar subluxation of the narrowed carpal tunnel resulted in flexor tendon attrition against the hamate hook. A side-to-side tendon transfer was performed along with a lunotriquetral ligament repair and temporary Kirschner wire fixation. At 6 months the patient had full active, synchronous flexion of the ring and little fingers and reduced wrist pain. Literature Review Traumatic flexor tendon ruptures have been reported following distal radius/hamate hook fractures, from carpal bone osteophytes, accessory carpal bones and intraosseous ganglia. Attritional ruptures caused by chronic, degenerative carpal pathology are less common. Clinical Relevance This case highlights an unusual cause of flexor tendon rupture due to chronic carpal instability. PMID:25032080

  20. Flexor origin slide for contracture of spastic finger flexor muscles: a retrospective study.

    PubMed

    Thevenin-Lemoine, Camille; Denormandie, Philippe; Schnitzler, Alexis; Lautridou, Christine; Allieu, Yves; Genêt, François

    2013-03-06

    Contracture of the wrist and extrinsic finger flexor and pronator muscles is a common consequence of central nervous system disorders. The proximal release of the extrinsic flexor and pronator muscles was first described by Page and Scaglietti for a Volkmann contracture. The aim of the present study was to assess the amount of increase in extension and the improvements in global hand function that can be expected following this lengthening procedure in patients with central nervous system disorders. A single-center retrospective review of patients with central nervous system lesions and contractures of the wrist and extrinsic finger flexor and forearm pronator muscles, causing aesthetic, hygienic, or functional impairment, was carried out. The Page-Scaglietti technique was used for all interventions. Before the operation, motor nerve blocks were used to distinguish between spasticity and contractures with surgical intervention only for contractures. The Zancolli and House classifications were used to evaluate improvements. Data from fifty-four hands and fifty patients (thirty-five men and fifteen women) were evaluated. The mean duration of follow-up (and standard deviation) was 26 ± 21 months (range, three to 124 months). The mean gain (and standard deviation) in wrist extension with fingers extended was 67° ± 25° (range, -10° to 110°). Preoperatively, no hands were classified as Zancolli Group 1, whereas twenty-five hands were classified as Zancolli Group 1 at the latest follow-up review. Ten nonfunctional hands (rated as House Group 0 or Group 1) became functional as a supporting hand postoperatively. Zancolli and House classifications increased significantly (p < 0.01) postoperatively. In twelve cases, a partial recurrence of the deformity occurred. In seven of these cases, surgery unmasked spasticity or contracture of the intrinsic muscles, which required further intervention. The Page-Scaglietti technique appears to improve range of motion and function

  1. Human flexor tendon tissue engineering: decellularization of human flexor tendons reduces immunogenicity in vivo.

    PubMed

    Raghavan, Shyam S; Woon, Colin Y L; Kraus, Armin; Megerle, Kai; Choi, Matthew S S; Pridgen, Brian C; Pham, Hung; Chang, James

    2012-04-01

    In mutilating hand injuries, tissue engineered tendon grafts may provide a reconstructive solution. We have previously described a method to decellularize cadaveric human flexor tendons while preserving mechanical properties and biocompatibility. The purpose of this study is to evaluate the immunogenicity and strength of these grafts when implanted into an immunocompetent rat model. Cadaveric human flexor tendons were divided into two groups. Group 1 was untreated, and Group 2 was decellularized by treatment with sodium dodecyl sulfate (SDS), ethylenediaminetetraacetic acid (EDTA), and peracetic acid (PAA). Both groups were then analyzed for the presence of major histocompatibility complexes by immunohistochemistry (IHC). Pair-matched tendons from each group were then placed into the dorsal subcutaneous tissue and anchored to the spinal ligaments of Wistar rats for 2 or 4 weeks, and harvested. The infiltration of B-cells and macrophages was determined using IHC. The explants where then subjected to mechanical testing to determine the ultimate tensile stress (UTS) and elastic modulus (EM). Statistical analysis was performed using a paired Student's t-test. The decellularization protocol successfully removed cells and MHC-1 complexes. At 2 weeks after implantation, there was increased infiltration of B-cells in Group 1 (untreated) compared with Group 2 (acellular), both in the capsule and tendon substance. There was improved ultimate tensile stress (UTS, 42.7 ± 8.3 vs. 22.8 ± 7.8 MPa, p<0.05) and EM (830.2 ± 206.7 vs. 421.2 ± 171.3 MPa, p<0.05) in tendons that were decellularized. At 4 weeks, there was continued B-cell infiltration in Group 1 (untreated) compared with Group 2 (acellular). There was no appreciable difference in macrophage infiltration at both time points. At 4 weeks Group 2 (acellular) demonstrated persistently greater UTS (40.5 ± 9.1 vs. 14.6 ± 4.2 MPa, p<0.05) and EM (454.05 ± 101.5 vs. 204.6 ± 91.3 MPa, p<0.05) compared with Group 1

  2. Flexor tendon tissue engineering: acellularization of human flexor tendons with preservation of biomechanical properties and biocompatibility.

    PubMed

    Pridgen, Brian C; Woon, Colin Y L; Kim, Maxwell; Thorfinn, Johan; Lindsey, Derek; Pham, Hung; Chang, James

    2011-08-01

    Acellular human tendons are a candidate scaffold for tissue engineering flexor tendons of the hand. This study compared acellularization methods and their compatibility with allogeneic human cells. Human flexor tendons were pretreated with 0.1% ethylenediaminetetracetic acid (EDTA) for 4  h followed by 24  h treatments of 1% Triton X-100, 1% tri(n-butyl)phosphate, or 0.1% or 1% sodium dodecyl sulfate (SDS) in 0.1% EDTA. Outcomes were assessed histologically by hematoxylin and eosin and SYTO green fluorescent nucleic acid stains and biochemically by a QIAGEN DNeasy kit, Sircol collagen assay, and 1,9 dimethylmethylene blue glycosaminoglycan assay. Mechanical data were collected using a Materials Testing System to pull to failure tendons acellularized with 0.1% SDS. Acellularized tendons were re-seeded in a suspension of human dermal fibroblasts. Attachment of viable cells to acellularized tendon was assessed biochemically by a cell viability assay and histologically by a live/dead stain. Data are reported as mean±standard deviation. Compared with the DNA content of fresh tendons (551±212  ng DNA/mg tendon), only SDS treatments significantly decreased DNA content (1% SDS [202.8±37.4  ng DNA/mg dry weight tendon]; 0.1% SDS [189±104  ng DNA/mg tendon]). These findings were confirmed by histology. There was no decrease in glycosaminoglycans or collagen following acellularization with SDS. There was no difference in the ultimate tensile stress (55.3±19.2 [fresh] vs. 51.5±6.9 [0.1% SDS] MPa). Re-seeded tendons demonstrated attachment of viable cells to the tendon surface using a viability assay and histology. Human flexor tendons were acellularized with 0.1% SDS in 0.1% EDTA for 24  h with preservation of mechanical properties. Preservation of collagen and glycoaminoglycans and re-seeding with human cells suggest that this scaffold is biocompatible. This will provide a promising scaffold for future human flexor tendon tissue engineering studies to

  3. Measurement of cervical flexor endurance following whiplash.

    PubMed

    Kumbhare, Dinesh A; Balsor, Brad; Parkinson, William L; Harding Bsckin, Peter; Bedard, Michel; Papaioannou, Alexandra; Adachi, Jonathan D

    2005-07-22

    To investigate measurement properties of a practical test of cervical flexor endurance (CFE) in whiplash patients including inter-rater reliability, sensitivity to clinical change, criterion related validity against the Neck Disability Index (NDI), and discriminant validity for injured versus uninjured populations. Two samples were recruited, 81 whiplash patients, and a convenience sample of 160 subjects who were not seeking treatment and met criteria for normal pain and range of motion. CFE was measured using a stopwatch while the subject, in crook lying, held their head against gravity to fatigue. Inter-rater reliability in whiplash patients was in a range considered 'almost perfect' (Intraclass Correlation=0.96). CFE had greater inter-subject variability than the NDI or range of motion in any of three planes. However, the effect size for improvement in CFE over treatment was as large as the effect sizes for all of those measures. In multivariate regression, CFE changes accounted for changes on the NDI better than the three ranges of motion. CFE discriminated whiplash patients who were within six months of injury (n=71) from age and gender matched normals with high effect size (ES=1.5). These findings provide evidence of reliability and validity for CFE measurement, and demonstrate that CFE detects clinical improvements. Variance on CFE emphasizes the need to consider inter-, and intra-subject standard deviations to interpret scores.

  4. Mechanical compromise of partially lacerated flexor tendons.

    PubMed

    Kondratko, Jaclyn; Duenwald-Kuehl, Sarah; Lakes, Roderic; Vanderby, Ray

    2013-01-01

    Tendons function to transmit loads from muscle to move and stabilize joints and absorb impacts. Functionality of lacerated tendons is diminished, however clinical practice often considers surgical repair only after 50% or more of the tendon is lacerated, the "50% rule." Few studies provide mechanical insight into the 50% rule. In this study cyclic and static stress relaxation tests were performed on porcine flexor tendons before and after a 0.5, 1.0, 2.0, or 2.75 mm deep transverse, midsubstance laceration. Elastic and viscoelastic properties, such as maximum stress, change in stress throughout each test, and stiffness, were measured and compared pre- and post-laceration. Nominal stress and stiffness parameters decreased, albeit disproportionately in magnitude, with increasing percent loss of cross-sectional area. Conversely, mean stress at the residual area (determined using remaining intact area at the laceration cross section) exhibited a marked increase in stress concentration beginning at 47.2% laceration using both specified load and constant strain analyses. The marked increase in stress concentration beginning near 50% laceration provides mechanical insight into the 50% rule. Additionally, a drastic decrease in viscoelastic stress parameters after only an 8.2% laceration suggests that time-dependent mechanisms protecting tissues during impact loadings are highly compromised regardless of laceration size.

  5. Flexor Digitorum Longus (FDL) or Flexor Hallucis Longus (FHL) Harvesting: Technical Tip and Case Studies.

    PubMed

    Lehnert, Bruce; Nyska, Meir; Ip, Wing; Huynh, Em; Palmanovich, Ezequiel

    2017-09-01

    Harvesting of the flexor digitorum longus (FDL) or the flexor hallucis longus (FHL) is a procedure used when tendon transfer is needed. It is commonly used in tibialis posterior reconstruction and Achilles tendon reconstruction. Harvesting of these tendons is sometimes difficult and time-consuming. It is important to obtain sufficient length to make a loop around the navicular bone or anchor it in the calcaneus. We describe a technique in which a loop is passed from proximal identification of the FDL or FHL through the tendon sheath, harvesting it from a minimal plantar approach. After using this technique, we evaluated 10 consecutive patients for neurovascular damage. We found no postoperative neurovascular injuries. The technique described enables the surgeon to find the FDL/FHL tendon through the medial approach and obtain sufficient length for the procedure by cutting the distal portion of the tendon through an additional plantar incision. Our technical tip for passing the loop facilitates harvest of the tendon easily and safely using the plantar approach. IV, case series.

  6. Flexor Tendon Repair With Looped Suture: 1 Versus 2 Knots.

    PubMed

    Gil, Joseph A; Skjong, Christian; Katarincic, Julia A; Got, Christopher

    2016-03-01

    To assess the strength of flexor tendon repair with looped suture. We hypothesized that, after passing the intact looped suture in the desired repair configuration, splitting the loop and tying 2 independent knots would increase the strength of flexor tendon repair. Thirty-two flexor tendons were harvested and were sharply transected in zone II. The tendons were repaired with a 4-strand core suture repair using 3-0 looped nonabsorbable nylon suture. The harvested tendons were randomly assigned and repaired with either a 1- or a 2-knot construct. The repaired flexor tendons were fixed in a servohydraulic material testing system and were loaded to failure either with uniaxial tension or cyclically. The average force at failure was 43 N for the 1-knot repair and 28 N for the 2-knot repair. The mode of failure of 15 of the flexor tendon repairs that were cyclically loaded to failure was suture pull-out. The average number of cycles and force in cyclic testing that caused failure of flexor tendon repairs was 134 cycles and 31 N for tendons repaired with looped 3-0 suture tied with 1 knot and 94 cycles and 33 N for tendons repaired with looped 3-0 suture tied with 2 knots. Our hypothesis was disproved by the results of this study. This study suggests that, when using looped suture, tying 2 independent knots instead of tying a single knot does not increase the strength of the flexor tendon repair. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Changes in carpal tunnel compliance with incremental flexor retinaculum release.

    PubMed

    Ratnaparkhi, Rubina; Xiu, Kaihua; Guo, Xin; Li, Zong-Ming

    2016-04-13

    Flexor retinaculum transection is a routine surgical treatment for carpal tunnel syndrome, yet the biomechanical and clinical sequelae of the procedure remain unclear. We investigated the effects of flexor retinaculum release on carpal tunnel structural compliance using cadaveric hands. The flexor retinaculum was incrementally and sequentially released with transections of 25, 50, 75, and 100 % of the transverse carpal ligament, followed by the distal aponeurosis and then the antebrachial fascia. Paired outward 10 N forces were applied to the insertion sites of the transverse carpal ligament at the distal (hamate-trapezium) and proximal (pisiform-scaphoid) levels of the carpal tunnel. Carpal tunnel compliance was defined as the change in carpal arch width normalized to the constant 10 N force. With the flexor retinaculum intact, carpal tunnel compliance at the proximal level, 0.696 ± 0.128 mm/N, was 13.6 times greater than that at the distal level, 0.056 ± 0.020 mm/N. Complete release of the transverse carpal ligament was required to achieve a significant gain in compliance at the distal level (p < 0.05). Subsequent release of the distal aponeurosis resulted in an appreciable additional increase in compliance (43.0 %, p = 0.052) at the distal level, but a minimal increase (1.7 %, p = 0.987) at the proximal level. Complete flexor retinaculum release provided a significant gain in compliance relative to transverse carpal ligament release alone at both proximal and distal levels (p < 0.05). Overall, complete flexor retinaculum release increased proximal compliance by 52 % and distal compliance by 332 %. The increase in carpal tunnel compliance with complete flexor retinaculum release helps explain the benefit of carpal tunnel release surgery for patients with carpal tunnel syndrome.

  8. Measurement of fatigue in knee flexor and extensor muscles.

    PubMed

    Kawabata, Y; Senda, M; Oka, T; Yagata, Y; Takahara, Y; Nagashima, H; Inoue, H

    2000-04-01

    In order to examine fatigue of the knee flexor and extensor muscles and to investigate the characteristics of muscular fatigue in different sports, a Cybex machine was used to measure muscle fatigue and recovery during isokinetic knee flexion and extension. Eighteen baseball players, 12 soccer players and 13 marathon runners were studied. Each subject was tested in the sitting position and made to perform 50 consecutive right knee bends and stretches at maximum strength. This was done 3 times with an interval of 10 min between each series. The peak torque to body weight ratio and the fatigue rate were determined in each case. In all subjects, the peak torque to body weight ratio was higher for extensors than flexors. Over the 3 trials, the fatigue rate of extensors showed little change, while that of flexors had a tendency to increase. In each subject, knee extensors showed a high fatigue rate but a quick recovery, while knee flexors showed a low fatigue rate but a slow recovery. As the marathon runners had the smallest fatigue rates for both flexors and extensors, we concluded that marathon runners had more stamina than baseball players and soccer players.

  9. The Cellular Biology of Flexor Tendon Adhesion Formation

    PubMed Central

    Wong, Jason K.F.; Lui, Yin H.; Kapacee, Zoher; Kadler, Karl E.; Ferguson, Mark W. J.; McGrouther, Duncan A.

    2009-01-01

    Intrasynovial flexor tendon injuries of the hand can frequently be complicated by tendon adhesions to the surrounding sheath, limiting finger function. We have developed a new tendon injury model in the mouse to investigate the three-dimensional cellular biology of intrasynovial flexor tendon healing and adhesion formation. We investigated the cell biology using markers for inflammation, proliferation, collagen synthesis, apoptosis, and vascularization/myofibroblasts. Quantitative immunohistochemical image analysis and three-dimensional reconstruction with cell mapping was performed on labeled serial sections. Flexor tendon adhesions were also assessed 21 days after wounding using transmission electron microscopy to examine the cell phenotypes in the wound. When the tendon has been immobilized, the mouse can form tendon adhesions in the flexor tendon sheath. The cell biology of tendon healing follows the classic wound healing response of inflammation, proliferation, synthesis, and apoptosis, but the greater activity occurs in the surrounding tissue. Cells that have multiple “fibripositors” and cells with cytoplasmic protrusions that contain multiple large and small diameter fibrils can be found in the wound during collagen synthesis. In conclusion, adhesion formation occurs due to scarring between two damaged surfaces. The mouse model for flexor tendon injury represents a new platform to study adhesion formation that is genetically tractable. PMID:19834058

  10. No man's land revisited: the primary flexor tendon repair controversy.

    PubMed

    Newmeyer, William L; Manske, Paul R

    2004-01-01

    New surgical procedures, novel concepts, and/or the presentation of very good results with an apparently discredited technique meet varying degrees of resistance among the establishment of any profession. In hand surgery this phenomenon was exemplified in a striking fashion with the presentation of a controversial report entitled, "Primary repair of flexor tendons in no man's land" by Kleinert, Kutz, Ashbell, and Martinez of Louisville, KY, at the 1967 American Society for Surgery of the Hand (ASSH) annual meeting. The discussant, Joseph Boyes, expressed such skepticism that a special ASSH committee was appointed to go to Louisville and review the results to determine if they were as good as claimed. They were, and today primary flexor tendon repair is the procedure of choice for most flexor tendon lacerations.

  11. Reliability of a measurement of neck flexor muscle endurance.

    PubMed

    Harris, Kevin D; Heer, Darren M; Roy, Tanja C; Santos, Diane M; Whitman, Julie M; Wainner, Robert S

    2005-12-01

    Neck flexor muscle endurance has been negatively correlated with cervical pain and dysfunction. The purposes of this study were to determine rater reliability in subjects both with and without neck pain and to determine whether there was a difference in neck flexor muscle endurance between the 2 groups. Forty-one subjects with and without neck pain were enrolled in this repeated-measures reliability study. Two raters used an isometric neck retraction test to assess neck flexor muscle endurance for all subjects during an initial session, and subjects without neck pain returned for testing 1 week later. For the group without neck pain, intrarater reliability was good to excellent (intraclass correlation coefficient [ICC(3,1)]=.82-.91), and interrater reliability was moderate to good (ICC[2,1]=.67-.78). The associated standard error of measurement (SEM) ranged from 8.0 to 11.0 seconds and from 12.6 to 15.3 seconds, respectively. For the group with neck pain, interrater reliability was moderate (ICC[2,1]=.67, SEM=11.5). Neck flexor muscle endurance test results for the group without neck pain (mean=38.95 seconds, SD=26.4) and the group with neck pain (mean=24.1 seconds, SD=12.8) were significantly different. Reliability coefficients differed between the 2 groups and ranged from moderate to excellent and improved after the first test session. The interrater reliability of data obtained with the neck flexor muscle endurance test in people with neck pain must be improved in order for clinicians to distinguish a clinically meaningful change from measurement error. Neck flexor muscle endurance was both statistically and clinically greater for subjects without neck pain than for those with neck pain.

  12. A variant of flexor carpi ulnaris causing ulnar nerve compression.

    PubMed Central

    al-Qattan, M M; Duerksen, F

    1992-01-01

    Anatomical variations of the muscles and nerves around the wrist are common. Knowledge of such variations is derived from 2 sources: anatomical dissections and clinically reported cases. We present a case of duplication of the tendon of flexor carpi ulnaris with splitting of the ulnar nerve. The ulnar slip of the tendon was inserted into the pisiform bone and the radial slip into the proximal phalanx of the ring finger. The anatomical literature and the clinically reported cases of variations of the flexor carpi ulnaris are reviewed. Images Fig. 1 PMID:1452475

  13. Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction.

    PubMed

    Wei, David H; Terrono, Andrew L

    2015-10-01

    Swan neck deformity, or hyperextension of the proximal interphalangeal joint, may occur secondary to trauma, rheumatoid arthritis, cerebral palsy, or Ehlers-Danlos syndrome, and can be treated with tenodesis of one slip of the flexor digitorum sublimis tendon. This technique has several variations, differing primarily in the specific location and method that a single slip of the flexor digitorum sublimis tendon is secured, but they all serve to create a static volar restraint against hyperextension. Options include tunneling the tendon through the bone of the proximal phalanx, attaching the tendon to the A1 or A2 pulley, or securing the tendon with bone anchors in the proximal phalanx.

  14. Primary flexor tendon surgery: the search for a perfect result.

    PubMed

    Elliot, David; Giesen, Thomas

    2013-05-01

    Repair of the divided flexor tendon to achieve normal, or near normal, function is an unsolved problem, with each result still uncertain. The authors believe the way forward in primary flexor tendon surgery clinically is by use of strengthened but simpler sutures, appropriate venting of the pulley system, and maintaining early rehabilitation. However, there needs also be consideration of patient factors and other aspects. Research needs to continue more widely, in both the laboratory and the clinical environment, to find ways of better modifying adhesions after surgical repair of the tendon.

  15. Septic flexor tendonitis and suspensory desmitis in an alpaca.

    PubMed

    Hunter, Barbara G; Semevolos, Stacy A

    2013-07-01

    A 2-year-old male Suri alpaca was referred for evaluation of severe right forelimb lameness of 2 weeks' duration following a traumatic episode. Examination of the distal aspect of the metacarpus revealed 4 wounds exuding purulent material. On weight bearing, the metacarpophalangeal joint was severely hyperextended with the palmar surface touching the ground. Ultrasonography of the palmar surface of the metacarpus revealed desmitis of the proximal suspensory ligament, a large core lesion of the deep digital flexor tendon at mid-metacarpus, and complete loss of fiber pattern within the deep digital flexor tendon and lateral aspect of the superficial digital flexor tendon distally. The alpaca was treated systemically with antimicrobials and anti-inflammatory drugs and underwent repeated antimicrobial intraosseous regional limb perfusion. A bandage and splint were applied to stabilize the affected forelimb in an anatomically correct position, and the alpaca underwent prolonged stall confinement. At the time of hospital discharge 5 days after initial evaluation, clinical evidence of infection at the wound sites was absent. Three months following treatment, the alpaca was moving freely in a small paddock and had moderate hyperextension of the metacarpophalangeal joint. Treatment of septic flexor tendonitis and suspensory desmitis with antimicrobial intraosseous regional limb perfusion in combination with systemic treatment with antimicrobials and orthopedic support resulted in an excellent outcome in this alpaca. Antimicrobial intraosseous regional limb perfusion is simple to perform and has the potential to be beneficial in the treatment of infections in the distal portion of a limb in camelids.

  16. Clinical outcome after percutaneous flexor tenotomy in forefoot surgery.

    PubMed

    Debarge, Romain; Philippot, Rémy; Viola, Jérémy; Besse, Jean Luc

    2009-10-01

    The aim of this study was to evaluate the outcome of the percutaneous flexor tenotomy. We compared the results of two groups. The first group included 23 patients who underwent forefoot surgery without percutaneous flexor tenotomy, and the second group included 50 patients who underwent the same procedure combined with percutaneous flexor tenotomy for claw toe deformities, secondary to shortening metatarsal Scarf osteotomy. The average follow-up was 11.6 months. Three algoneurodystrophies were noted. No delayed wound healing was observed. Functional dissatisfaction rate (18% vs.17.4%) and toe pulp contact defect (12% vs. 8.7%) were not significantly different in the two groups. Toe grasping defect rate (10% vs. 4.3%) was superior in the tenotomy group. Five recurring claw toe deformities of the second toe were noted in the tenotomy group. Percutaneous flexor tenotomy is a simple, rapid, and efficient method to correct reducible secondary claw toe deformities. However, despite a significant postoperative loss of toe grasping function, no patient reported major dissatisfaction.

  17. History and Nomenclature of Multistrand Repairs in Digital Flexor Tendons.

    PubMed

    Savage, Robert; Tang, Jin Bo

    2016-02-01

    Multistrand core suture repairs have become the mainstay of digital flexor tendon repair in recent decades. Here we briefly describe the history of the development of these multistrand repair methods and their correct nomenclature. A historical account, their evolution, the correct use of nomenclature, and some technical points are reviewed.

  18. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    PubMed Central

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592

  19. Flexor Tendon Repair Postoperative Rehabilitation: The Saint John Protocol

    PubMed Central

    Higgins, Amanda

    2016-01-01

    Summary: The Saint John Protocol describes a rehabilitation program of up to half a fist of protected true active finger flexion beginning 3 to 5 days after flexor tendon repair. We no longer use full fist place and hold. We illustrate with film and text the reasons for these changes. PMID:27975032

  20. Plantar forces in flexor hallucis longus versus flexor digitorum longus transfer in adult acquired flatfoot deformity.

    PubMed

    Spratley, E Meade; Arnold, John M; Owen, John R; Glezos, Christopher D; Adelaar, Robert S; Wayne, Jennifer S

    2013-09-01

    Flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon transfers are frequently used to restore the function of a deficient tibialis posterior tendon in stage II adult acquired flatfoot deformity (AAFD). Either transfer causes some loss in toe flexion force, although the decision to tenodese the cut tendon to restore associated function remains controversial. This study quantified changes in plantar force before and after tendon transfer and with or without distal tenodesis in a cadaveric model. The plantar force distribution of 10 matched pairs of statically loaded cadaveric lower extremities was investigated. Each foot was tested when it was intact, after FDL/FHL tendon transfer, and after tendon transfer + tenodesis. Transfer of either FHL or FDL showed a statistically significant decrease in flexion force of the great toe (P < .01) and lesser toes (P < .001), respectively. Subsequent tenodesis in either tendon demonstrated an ability to restore flexion force in the great (P < .05) and lesser (P < .01) toes, respectively, with the FHL transfer + tenodesis restoring great toe loading to near pretransfer levels. Following either transfer, plantar force increased in the medial forefoot; this was sustained with FDL transfer + tenodesis but reduced under FHL transfer + tenodesis. Lateral forefoot force increased modestly (8%) with FHL transfer (P < .05) but returned to near intact levels with tenodesis. FDL transfer + tenodesis resulted in increased medial midfoot and heel loading. FHL or FDL transfer notably reduces associated toe flexion force. This loss can be restored to near normal levels with tenodesis for FHL transfer. As increased lateral forefoot loading is commonly associated with AAFD corrective procedures, FHL tenodesis may mitigate the unintended increases caused by the tendon transfer. The medial midfoot and heel loading with FDL transfer + tenodesis underscores that tendon transfers alone do not reestablish the passive architecture of

  1. Acute Traumatic Musculotendinous Avulsion of the Flexor Pollicis Longus Tendon Treated with Primary Flexor Digitorum Superficialis Transfer: A Novel Technique of Management

    PubMed Central

    Sasi, P. Kiran; Mahapatra, Swagath; Raj Pallapati, Samuel C.; Thomas, Binu P.

    2016-01-01

    Traumatic musculotendinous junction avulsions are rare injuries except in avulsion amputations. They pose a significant challenge to the treating surgeon. We present a 24-year-old male who sustained an open musculotendinous avulsion of the flexor pollicis longus tendon. He was treated with primary tendon transfer using the flexor digitorum superficialis of ring finger, in flexor zone 3. The functional result at 10 months following surgery was excellent. PMID:27019757

  2. Accuracy of Visual Estimates of Partial Flexor Tendon Lacerations.

    PubMed

    Pritsch, Tamir; Wong, Corrine; Sammer, Douglas M

    2015-12-01

    To determine whether hand surgeons could accurately and consistently estimate the size of partial flexor tendon lacerations. Thirty-two partial flexor tendon lacerations were made in the flexor digitorum profundus tendons of a fresh-frozen cadaveric hand. Four hand surgeons and 5 residents estimated the size of the lacerations. Estimates were repeated 3 days later. Magnified images of the laceration cross-section were used to calculate the true size of each laceration. Inter- and intrarater reliability were calculated using the intraclass correlation coefficient. Accuracy was measured with the mean bias error and the mean absolute error. Interrater and intrarater reliabilities were both high. There was a high level of consistency for both surgeons and residents. In terms of accuracy, there was a 3% bias toward underestimation. The mean absolute error was 11%. There was no statistically significant difference between the accuracy of attending hand surgeons and that of residents. Participants were less accurate when estimating lacerations close to a 60% laceration threshold for surgical repair (lacerations in the 50%-70% range). For lacerations within this range, an incorrect management decision would have been made 17% of the time, compared with 7% of the time for lacerations outside that range. The accuracy and reliability of surgeon estimates of partial flexor tendon laceration size were high for surgeons and residents. Accuracy was lower for lacerations close to the threshold for repair. Visual estimation is acceptable for evaluating partial flexor tendon lacerations, but it may be less reliable for lacerations near the threshold for repair. Therefore, surgeons should be cautious when deciding whether or not to repair partial lacerations in the borderline range. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Biomechanical Study of the Digital Flexor Tendon Sliding Lengthening Technique.

    PubMed

    Hashimoto, Ken; Kuniyoshi, Kazuki; Suzuki, Takane; Hiwatari, Ryo; Matsuura, Yusuke; Takahashi, Kazuhisa

    2015-10-01

    To compare the mechanical properties of sliding lengthening (SL) and Z-lengthening (ZL) for flexor tendon elongation used for conditions such as Volkmann contracture, cerebral palsy, and poststroke spasticity. We harvested 56 flexor tendons, including flexor pollicis longus tendons, flexor digitorum superficialis tendons (zones II to IV), and flexor digitorum profundus tendons (zones II to V) from 24 upper limbs of 12 fresh cadavers. Each tendon was harvested together with its homonymous tendon from the opposite side of the cadaver and paired. We used 28 pairs of tendons and divided them randomly into 4 groups depending on the lengthening distance (20 or 30 mm) and type of stitching (single or double mattress sutures). Then we divided each pair into either the SL or ZL group. Each group was composed of 7 specimens. The same surgeon lengthened all tendons and stitched them with 2-0 polyester sutures. We tested biomechanical tensile strength immediately after completing lengthening and suturing in each group. Ultimate tensile strengths were: 23 N for the SL 20-mm lengthening and single mattress suture and 7 N for the ZL; 25 N for the SL 20-mm lengthening and double mattress suture and 10 N for the ZL; 15 N for the SL 30-mm lengthening and single mattress suture and 8 N for the ZL; and 18 N for the SL 30-mm lengthening and double mattress suture and 10 N for the ZL. The SL technique may be a good alternative to the ZL technique because it provides higher ultimate tensile strength. Because of its higher ultimate tensile strength, the SL technique may allow for earlier rehabilitation and reduced risk of postoperative complications. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Amplitude transitions of swimmers and flexors in viscoelastic fluids

    NASA Astrophysics Data System (ADS)

    Guy, Robert; Thomases, Becca

    2015-11-01

    In both theoretical and experimental studies of the effect of fluid elasticity on micro-organism swimming, very different behavior has been observed for small and large amplitude strokes. We present simulations of an undulatory swimmer in an Oldroyd-B fluid and show that the resulting viscoelastic stresses are a nonlinear function of the amplitude. Specifically, there appears to be an amplitude dependent transition that is key to obtaining a speed-up over the Newtonian swimming speed. To understand the physical mechanism of the transition, we examine the stresses in a time-symmetric oscillatory bending beam, or flexor. We compare the flow in a neighborhood of the flexor tips with a large-amplitude oscillatory extensional flow, and we see similar amplitude dependent transitions. We relate these transitions to observed speed-ups in viscoelastic swimmers.

  5. Ultrasound of the digital flexor system: Normal and pathological findings☆

    PubMed Central

    Bianchi, S.; Martinoli, C.; de Gautard, R.; Gaignot, C.

    2007-01-01

    Recent improvements in ultrasound (US) software and hardware have markedly increased the role of this imaging modality in the evaluation of the musculoskeletal system. US is currently one of the main imaging tools used to diagnose and assess most tendon, muscle, and ligament disorders. Compared with magnetic resonance imaging, US is much less expensive; it has no contraindications and is also widely available. Diseases affecting the digital flexor system (DFS) require early diagnosis if treatment is expected to limit functional impairment of the hand. US scans performed with high-resolution, broad-band transducers allows superb visualization of the flexor tendons of the hand and the annular digital pulleys. In addition, dynamic US can be used to assess movement of the tendon within the pulleys during passive or active joint movements. This article examines the anatomy and US appearance of the normal DFS and reviews the US findings associated with the most common disorders affecting it. PMID:23396583

  6. Case report: accessory head of the deep forearm flexors

    PubMed Central

    JONES, M.; ABRAHAMS, P. H.; SAÑUDO, J. R.

    1997-01-01

    In 1813 Gantzer described 2 accessory muscles in the human forearm which bear his name (Wood, 1868; Macalister, 1875) and these have subsequently been reported with variable attachments (Wood, 1868; Macalister, 1875; Turner, 1879; Schäfer & Thane, 1894; Le Double, 1897; Dykes & Anson, 1944; Mangini, 1960; Malhotra et al. 1982; Kida, 1988; Tountas & Bergman, 1993). The accessory heads of the deep flexors of the forearm (Gantzer's muscles) have been described as 2 different small bellies which insert either into FPL or FDP. There are no previous reports which have mentioned the existence of an accessory muscle which inserts into both of the 2 deep flexors of the forearm as in the case presented here. PMID:9306208

  7. Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo.

    PubMed

    Thorfinn, J; Angelidis, I K; Gigliello, L; Pham, H M; Lindsey, D; Chang, J

    2012-02-01

    Tissue-engineered rabbit flexor tendons reseeded with cells are stronger in vitro after culture in a bioreactor. It is not known whether this effect persists in vivo. Tenocytes from New Zealand white rabbits were seeded onto rabbit rear paw flexor tendons that were deprived of cells and exposed to cyclic strain in a bioreactor. Reseeded constructs that were kept unloaded in a medium for 5 days were used as controls. The tendons were implanted to bridge a zone II defect in the rabbit. After explantation 4 weeks later, the ultimate tensile strength (UTS) and elastic modulus (EM) were determined. Tendon constructs that were exposed to cyclic strain had significantly improved UTS and EM. Histology showed that cellularity was increased in the bioreactor tendons.

  8. Anatomical study of toe flexion by flexor hallucis longus.

    PubMed

    Edama, Mutsuaki; Kubo, Masayoshi; Onishi, Hideaki; Takabayashi, Tomoya; Yokoyama, Erika; Inai, Takuma; Watanabe, Hiroshi; Nashimoto, Satoshi; Kageyama, Ikuo

    2016-03-01

    Because connections exist between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL), the FHL is surmised to exert a flexion action on the lesser toes, but this has not been studied quantitatively. The objectives of this study have thus been to clarify the types of FHL and FDL connections and branching, and to deduce the toe flexion actions of the FHL. One hundred legs from 55 cadavers were used for the study, with FHLs and FDLs harvested from the plantar aspect of the foot, and connections and branches classified. Image-analysis software was then used to analyze cross-sectional areas (CSAs) of each tendon, and the proportion of FHL was calculated in relation to flexor tendons of each toe. Type I (single slip from FHL to FDL tendon) was seen in 86 legs (86%), Type II (crossed connection) in 3 legs (3%), and Type III (single slip from FDL to FHL tendon) or Type IV (no connection between muscles) in 0 legs (0%). In addition, Type V (double slip from FHL to FDL tendon) was seen in 11 legs (11%), representing a new type not recorded in previous classifications. In terms of the various flexor tendons, the proportion of FHL showing tendons to toes 2 and 3 was high, at approximately 50-70%. Consequently, considering the branching type and proportion of CSA, the FHL was conjectured to not only act to flex the hallux, but also play a significant role in the flexion of toes 2 and 3. These results offer useful information for future clarification of the functional roles of tendinous slips from the FHL. Copyright © 2015 Elsevier GmbH. All rights reserved.

  9. Partial Flexor Tendon Laceration Assessment: Interobserver and Intraobserver Reliability.

    PubMed

    Barker, B Justin; Kolovich, Gregory P; Klinefelter, Ryan D

    2016-01-01

    Accurate assessment of partial-thickness flexor tendon lacerations in the hand is difficult owing to the subjectivity of evaluation. In this study, we created 12 partial-thickness flexor tendon lacerations in a cadaveric hand, evaluated the accuracy of 6 orthopedic residents and 4 fellowship-trained hand surgeons in estimating the percentage thickness of each laceration, and assessed the groups' interobserver and intraobserver agreement. The 10 participants estimated each laceration independently and on 2 separate occasions and indicated whether they would repair it. The actual thickness of each laceration was calculated from measurements made with a pair of digital microcalipers. Overall estimates differed significantly from calibrated measurements. Estimates grouped by residents and fellowship-trained hand surgeons also differed significantly. Third-year residents were the most accurate residents, and fellowship-trained hand surgeons were more accurate than residents. Overall interobserver agreement was poor for both readings. There was moderate overall intraobserver agreement. Fellowship-trained hand surgeons and first-year residents had the highest intraobserver agreement. These results highlight the difficulty in accurately assessing flexor tendon lacerations. Accuracy appears not to improve with surgeon experience.

  10. Reliability of a clinical test for deep cervical flexor endurance.

    PubMed

    Olson, Lee E; Millar, A Lynn; Dunker, Jeremy; Hicks, Jennifer; Glanz, Devin

    2006-02-01

    Endurance deficiencies of the deep cervical flexors are associated with pain, increased lordosis, and headache. A need exists for reliable clinical tests of flexor endurance. This study determined intrarater and interrater reliability of such a test in persons without neck pain. Twenty-seven subjects (aged 20-35 years) without a history of neck pain or injury were tested. Supine subjects were timed in maintaining a position involving two components: (1) craniovertebral flexion (chin tuck) and (2) lower cervical flexion (holding the occiput at a fixed height). Each subject was examined twice by 3 different examiners with 1 to 2 days between trials. When two values were averaged, interrater reliability for the 3 testers was 0.83, 0.85, and 0.88. Intrarater reliability values were 0.78 and 0.85 for tests 1 and 2, respectively. The flexor endurance test showed good intertester and intratester reliability when two values were averaged and, thus, may represent a useful clinical tool for practitioners involved in treating and preventing neck pain.

  11. Changes in hip flexor passive compliance do not account for improvement in vertical jump performance after hip flexor static stretching.

    PubMed

    Wakefield, C Brent; Cottrell, G Trevor

    2015-06-01

    To date, there is limited research investigating stretching of antagonist muscles and its effects on agonist muscle function. The purpose of this research was to investigate the effects of pre-static stretching (pre-SS) of the hip flexor musculature on passive hip extension range of motion (ROM) and vertical jump height. Fifteen subjects reported to the laboratory on 4 separate days (D1, D2, D3, and D4). D1 was for familiarization, while on D2 to D4, subjects randomly completed 1 of 3 intervention conditions; no stretch (CON), hip flexor stretch (HFS), or hip extensor stretch (HES). Subject's pre- and post-intervention hip extension ROM were measured before performing 3 sets of pre- and post-maximal counter-movement vertical jumps. Vertical jump height was normalized to baseline for data analysis. A repeated-measures ANOVA with post hoc paired sample t-tests revealed a significant increase in vertical jump height in the HFS condition (1.74% ± 0.73; p ≤ 0.05) when compared with CON (-1.34% ± 0.96) or HES (-1.74% ± 0.65) conditions. There was also a significant increase in hip extension ROM after the HFS stretching protocol (6.5 ± 2.75%; p ≤ 0.05) when compared with the CON protocol (-1.73 ± 3.26); however, no significant difference when compared with the HES protocol (1.84 ± 2.79). A correlation analysis showed that the relative hip laxity of each subject had no effect on response to either condition nor did the magnitude of hip ROM change predict improvement in vertical jump. These results suggest that performing SS of the hip flexors may enhance vertical jump performance independent of changes in passive compliance of the hip flexor muscular tendon unit.

  12. Toe Flexor Strength, Flexibility and Function and Flexor Hallucis Longus Tendon Morphology in Dancers and Non-Dancers.

    PubMed

    Rowley, K Michael; Jarvis, Danielle N; Kurihara, Toshiyuki; Chang, Yu-Jen; Fietzer, Abbigail L; Kulig, Kornelia

    2015-09-01

    Tendinopathy of the flexor hallucis longus (FHL), colloquially referred to as "dancer's tendinitis," is a common condition in dancers and attributed to high demand on this muscle in positions of extreme ankle plantarflexion and metatarsophalangeal (MTP)) flexion and extension. Despite such a high prevalence, there has been little research into preventative or nonsurgical interventions. As a means to identify potential targets for prevention and intervention, this study aimed to characterize toe flexors in dancers by measuring strength, flexibility, function, and FHL tendon morphology. Dancers (n=25) were compared to non-dancers (n=25) in toe flexor isometric strength, first MTP joint range of motion, foot longitudinal arch flexibility, balance ability, endurance during modified heel raises without use of the toes, and FHL tendon thickness, cross-sectional area, and peak spatial frequency. Significant differences were found in functional first MTP joint extension (dancers 101.95°, non-dancers 91.15°, p<0.001), balance ability during single-leg stance on the toes (dancers 11.43 s, non-dancers 5.90 s, p=0.013), and during modified heel raises (dancers 22.20 reps, non-dancers 28.80 reps, p=0.001). Findings indicate that dancers rely on toe flexors more than non-dancers to complete balance and heel raise tasks. Efficacy of using this modified heel raise task with the toes off the edge of a block as a means to train larger plantarflexors and as a nonsurgical intervention should be studied in the future. Improving interventions for FHL tendinopathy will be impactful for dancers, in whom this condition is highly prevalent.

  13. A combined variation of Palmaris longus and Flexor digitorum superficialis: Case report and review of literature.

    PubMed

    Bernardes, A; Melo, C; Pinheiro, S

    2016-12-01

    The muscles of the anterior compartment of the forearm often exhibit anatomic variations. During dissection of the upper right limb of a preserved cadaver, morphological variations in the Palmaris longus and Flexor digitorum superficialis muscles were found. The Palmaris longus muscular fibers converged to a tendon that passed beneath the Flexor retinaculum, and inserted at the base of the middle phalanx of the fourth digit, replacing the tendon of Flexor digitorum superficialis. The Flexor digitorum superficialis was divided into two muscular heads: a digastric medial head giving tendons to the second and fifth digits, and a lateral head giving one tendon to the third digit. All these tendons were inserted in the respective digits by two bundles between which were located the tendon of the Flexor digitorum profundus muscle. Variations of flexor muscles must be documented because of their clinical significance and their potential use of these muscles in orthopaedic and reconstructive surgery. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  14. Measuring hip flexor and extensor strengths across various postures using a fixed belt

    PubMed Central

    Yoshizawa, Takashi; Higashi, Kentarou; Katou, Tomohiko

    2017-01-01

    [Purpose] The purpose of this study was to evaluate hip flexor and extensor strength due to differences in posture measurement. [Subjects and Methods] Healthy adults (26 males and 24 females) were enrolled. Using a hand-held dynamometer, hip flexor and extensor strengths were measured in various postures and in a basic posture (sitting posture and hip/knee joint flexed 90°) according to the Manual Muscle Testing procedure. While calculating intraclass correlation coefficients by measurement, hip flexor and extensor strengths were compared in males and females for every posture. [Results] Intraclass correlation coefficients were greater than 0.7 in every measurement. There was no significant difference in hip flexor and extensor strengths in both males and females. Furthermore, there was a significant difference in right and left hip flexor strengths and in left hip extensor strength. [Conclusion] Hip flexor and extensor strengths can be simply and easily measured using a hand-held dynamometer. PMID:28533587

  15. Measuring hip flexor and extensor strengths across various postures using a fixed belt.

    PubMed

    Yoshizawa, Takashi; Higashi, Kentarou; Katou, Tomohiko

    2017-04-01

    [Purpose] The purpose of this study was to evaluate hip flexor and extensor strength due to differences in posture measurement. [Subjects and Methods] Healthy adults (26 males and 24 females) were enrolled. Using a hand-held dynamometer, hip flexor and extensor strengths were measured in various postures and in a basic posture (sitting posture and hip/knee joint flexed 90°) according to the Manual Muscle Testing procedure. While calculating intraclass correlation coefficients by measurement, hip flexor and extensor strengths were compared in males and females for every posture. [Results] Intraclass correlation coefficients were greater than 0.7 in every measurement. There was no significant difference in hip flexor and extensor strengths in both males and females. Furthermore, there was a significant difference in right and left hip flexor strengths and in left hip extensor strength. [Conclusion] Hip flexor and extensor strengths can be simply and easily measured using a hand-held dynamometer.

  16. DAS performance analysis

    SciTech Connect

    Bates, G.; Bodine, S.; Carroll, T.; Keller, M.

    1984-02-01

    This report begins with an overview of the Data Acquisition System (DAS), which supports several of PPPL's experimental devices. Performance measurements which were taken on DAS and the tools used to make them are then described.

  17. Diagnosis and surgical management of flexor digitorum accessorius longus-induced tarsal tunnel syndrome.

    PubMed

    Wittmayer, Brian C; Freed, Lewis

    2007-01-01

    The flexor digitorum accessorius longus is a rare muscular occurrence in the lower extremity. It has been reported as an etiology of tarsal tunnel syndrome through prior case reports. By means of individual case study, we revisit flexor digitorum accessorius longus as a cause of tarsal tunnel syndrome. This case study discusses diagnosis along with surgical treatment of tarsal tunnel syndrome induced by the presence of flexor digitorum accessorius longus.

  18. Early reduction in toe flexor strength is associated with physical activity in elderly men

    PubMed Central

    Suwa, Masataka; Imoto, Takayuki; Kida, Akira; Yokochi, Takashi

    2016-01-01

    [Purpose] To compare the toe flexor, hand grip and knee extensor strengths of young and elderly men, and to examine the association between toe flexor strength and physical activity or inactivity levels. [Subjects and Methods] Young (n=155, 18–23 years) and elderly (n=60, 65–88 years) men participated in this study. Toe flexor, hand grip, and knee extensor strength were measured. Physical activity (time spent standing/walking per day) and inactivity (time spent sitting per day) were assessed using a self-administered questionnaire. [Results] Toe flexor, hand grip, and knee extensor strength of the elderly men were significantly lower than those of the young men. Standing/walking and sitting times of the elderly men were lower than those of the young men. Toe flexor strength correlated with hand grip and knee extensor strength in both groups. In elderly men, toe flexor strength correlated with standing/walking time. In comparison to the young men’s mean values, toe flexor strength was significantly lower than knee extensor and hand grip strength in the elderly group. [Conclusion] The results suggest that age-related reduction in toe flexor strength is greater than those of hand grip and knee extensor strengths. An early loss of toe flexor strength is likely associated with reduced physical activity in elderly men. PMID:27313353

  19. Tarsal tunnel syndrome and flexor hallucis longus tendon hypertrophy.

    PubMed

    Rodriguez, D; Devos Bevernage, B; Maldague, P; Deleu, P-A; Leemrijse, T

    2010-11-01

    Tarsal tunnel syndrome (TTS) defines an entrapment neuropathy of the posterior tibial nerve or one of its branches, within the tarsal tunnel. Numerous etiologies have been described explaining this entrapment, including trauma, space-occupying lesions, foot deformities, etc. We present an unreported cause of a space-occupying lesion in the etiology of TTS, namely the combination of a hypertrophic long distally extended muscle belly of the flexor hallucis longus and repetitive ankle motion. Surgical debulking of the muscle belly in the posterior ankle compartment resolved all symptoms.

  20. Functional anatomy of the human digital flexor pulley system.

    PubMed

    Lin, G T; Amadio, P C; An, K N; Cooney, W P

    1989-11-01

    The anatomy of 55 cadaver digits was studied, both statistically and with simulated active motion using weights attached to the flexor tendons. The modified description of Doyle and Blythe accurately described the anatomy observed. Serial pulley sectioning showed two types of bowstringing, both of which affected the relationship of tendon excursion to joint motion. The most constant, resulting in 15% loss of motion for a fixed tendon excursion, occurred over the concave surfaces of the proximal and middle phalanges. Bowstringing at the proximal interphalangeal joint was present only after 30 degrees of flexion had occurred, because of the convexity of the phalangeal condyles.

  1. Convergence of flexor reflex and corticospinal inputs on tibialis anterior network in humans.

    PubMed

    Mackey, Ann S; Uttaro, Denise; McDonough, Maureen P; Krivis, Lisa I; Knikou, Maria

    2016-01-01

    Integration between descending and ascending inputs at supraspinal and spinal levels is a key characteristic of neural control of movement. In this study, we characterized convergence of the flexor reflex and corticospinal inputs on the tibialis anterior (TA) network in healthy human subjects. Specifically, we characterized the modulation profiles of the spinal TA flexor reflex following subthreshold and suprathreshold transcranial magnetic stimulation (TMS). We also characterized the modulation profiles of the TA motor evoked potentials (MEPs) following medial arch foot stimulation at sensory and above reflex threshold. TA flexor reflexes were evoked following stimulation of the medial arch of the foot with a 30 ms pulse train at innocuous intensities. TA MEPs were evoked following TMS of the leg motor cortex area. TMS at 0.7 and at 1.2 MEP resting threshold increased the TA flexor reflex when TMS was delivered 40-100 ms after foot stimulation, and decreased the TA flexor reflex when TMS was delivered 25-110 ms before foot stimulation. Foot stimulation at sensory and above flexor reflex threshold induced a similar time-dependent modulation in resting TA MEPs, that were facilitated when foot stimulation was delivered 40-100 ms before TMS. The flexor reflex and MEPs recorded from the medial hamstring muscle were modulated in a similar manner to that observed for the TA flexor reflex and MEP. Cutaneomuscular afferents from the distal foot can increase the output of the leg motor cortex area. Descending motor volleys that directly or indirectly depolarize flexor motoneurons increase the output of the spinal FRA interneuronal network. The parallel facilitation of flexor MEPs and flexor reflexes is likely cortical in origin. Afferent mediated facilitation of corticospinal excitability can be utilized to strengthen motor cortex output in neurological disorders. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All

  2. Age-related reduction and independent predictors of toe flexor strength in middle-aged men.

    PubMed

    Suwa, Masataka; Imoto, Takayuki; Kida, Akira; Iwase, Mitsunori; Yokochi, Takashi

    2017-01-01

    Toe flexor muscles play an important role in posture and locomotion, and poor toe flexor strength is a risk factor for falls. In this cross-sectional study, we estimated the age-related change in toe flexor strength and compared it with that of handgrip strength. Independent factors predicting toe flexor and handgrip strength were also determined. A total of 1401 male (aged 35-59 years) study participants were divided into five groups according to their chronological age; 35-39, 40-44, 45-49, 50-54, and 55-59 years. Toe flexor and handgrip strength, anthropometry, and resting blood pressure were measured. Fasting blood samples were collected to measure blood glucose, triglycerides, high- and low-density lipoprotein-cholesterols, and albumin. A self-administered lifestyle questionnaire was conducted. Decline in absolute toe flexor and handgrip strength began in the age groups 50-55 and 55-59 years, respectively. In comparison to the mean values of the youngest group, relative toe flexor strength (87.0 ± 26.6%) was significantly lower than handgrip strength (94.4 ± 13.1%) for the oldest group. Multiple regression analyses showed that independent factors predicting both toe flexor and handgrip strength were lean body mass, age, serum albumin, drinking habit, and fat mass. Additionally, fasting blood glucose, diastolic blood pressure, sleeping time and exercise habit were predicting factors of toe flexor strength but not of handgrip strength. Age-related reduction in toe flexor strength was earlier and greater than handgrip strength, and toe flexor strength reflects body composition and metabolic status.

  3. "Swan neck deformity" of the second toe corrected by flexor digitorum longus to flexor digitorum brevis tenodesis.

    PubMed

    Lui, Tun Hing

    2015-04-01

    "Swan neck deformity" of the second toe is a rare deformity. It is a hyperextension of the proximal interphalangeal joint. The patient may complain of painful callosity underneath the proximal interphalangeal joint. Surgical correction should be considered if conservative treatment fails to relieve the pressure point. The optimal surgical option for this deformity has not yet been defined. We report a case of swan neck deformity of the second toe that was successfully corrected by flexor digitorum longus to brevis tenodesis. Therapeutic Level IV: Case Report. © 2014 The Author(s).

  4. [Chronic compartment syndrome of the flexor muscles in the forearm due to motocross].

    PubMed

    Jeschke, J; Baur, E M; Piza-Katzer, H

    2006-04-01

    A case of a mechanic and motorcyclist is reported who developed unilateral chronic exertional compartment syndrome of the flexor muscles in the forearm. After years of discomfort and medical check-ups, a subcutaneous fasciotomy of the superficial compartments of the flexor muscles in the forearm led to a complete relief of symptoms, which allowed the patient unrestricted activity.

  5. Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury.

    PubMed

    Smith, Andrew C; Mummidisetty, Chaithanya K; Rymer, William Zev; Knikou, Maria

    2014-11-01

    In humans, a chronic spinal cord injury (SCI) impairs the excitability of pathways mediating early flexor reflexes and increases the excitability of late, long-lasting flexor reflexes. We hypothesized that in individuals with SCI, locomotor training will alter the behavior of these spinally mediated reflexes. Nine individuals who had either chronic clinically motor complete or incomplete SCI received an average of 44 locomotor training sessions. Flexor reflexes, elicited via sural nerve stimulation of the right or left leg, were recorded from the ipsilateral tibialis anterior (TA) muscle before and after body weight support (BWS)-assisted treadmill training. The modulation pattern of the ipsilateral TA responses following innocuous stimulation of the right foot was also recorded in 10 healthy subjects while they stepped at 25% BWS to investigate whether body unloading during walking affects the behavior of these responses. Healthy subjects did not receive treadmill training. We observed a phase-dependent modulation of early TA flexor reflexes in healthy subjects with reduced body weight during walking. The early TA flexor reflexes were increased at heel contact, progressively decreased during the stance phase, and then increased throughout the swing phase. In individuals with SCI, locomotor training induced the reappearance of early TA flexor reflexes and changed the amplitude of late TA flexor reflexes during walking. Both early and late TA flexor reflexes were modulated in a phase-dependent pattern after training. These new findings support the adaptive capability of the injured nervous system to return to a prelesion excitability and integration state.

  6. In Vivo Tissue Interaction between the Transverse Carpal Ligament and Finger Flexor Tendons

    PubMed Central

    Gabra, Joseph N.; Gordon, Joshua L.; Marquardt, Tamara L.; Li, Zong-Ming

    2016-01-01

    The transverse carpal ligament (TCL) is a component of the flexor pulley system of the wrist, keeping the flexor tendons in place by resisting their volar displacement. The purpose of this study was to investigate the in vivo biomechanical interaction between the TCL and flexor tendons in response to tendon tensioning with the wrist at various postures. In eight healthy subjects, the flexor digitorum superficialis and profundus tendons were tensioned by isometrically applying loads (5, 10, and 15 N) to the index finger while the wrist posture was at 20° extension, neutral, 20° flexion, and 40° flexion. The TCL and flexor tendons were imaged at the distal carpal tunnel cross section using ultrasound. The volar-dorsal positions of the tendons, TCL arch height, and TCL-tendon distances were calculated. With increasing wrist flexion, the flexor tendons moved volarly, the TCL arch height increased, and the TCL-tendon distances decreased, indicating that the flexor tendons contacted the TCL and pushed it volarly. The TCL-tendon interaction was amplified by the combination of finger loading and wrist flexion. This study provides in vivo evidence of the biomechanical interaction between the TCL and flexor tendons. Repetitive TCL-tendon interactions may implicate the interacting tissues and the median nerve resulting in tissue maladaptation and nerve compression. PMID:27401044

  7. Epidemiology of Flexor Tendon Injuries of the Hand in a Northern Finnish Population.

    PubMed

    Manninen, M; Karjalainen, T; Määttä, J; Flinkkilä, T

    2017-09-01

    Flexor tendon injuries cause significant morbidity in working-age population. The epidemiology of these injuries in adult population is not well known. The aim of this study was to describe the epidemiology of flexor tendon injuries in a Northern Finnish population. Data on flexor tendon injuries, from 2004 to 2010, were retrieved from patient records from four hospitals, which offer surgical repair of the flexor tendon injuries in a well-defined area in Northern Finland. The incidence of flexor tendon injury as well as the gender-specific incidence rates was calculated. Mechanism of injury, concomitant nerve injuries, and re-operations were also recorded. The incidence rate of flexor tendon injury was 7.0/100,000 person-years. The incidence was higher in men and inversely related to age. The most common finger to be affected was the fifth digit. In 37% of injuries also digital nerve was affected. The most common finger to have simultaneous digital nerve injury was the thumb. Flexor tendon laceration is a relatively rare injury. It predominantly affects working-aged young males and frequently includes a nerve injury, which requires microsurgical skills from the surgeon performing the repair. This study describes epidemiology of flexor tendon injuries and therefore helps planning the surgical and rehabilitation services needed to address this entity.

  8. In vivo tissue interaction between the transverse carpal ligament and finger flexor tendons.

    PubMed

    Gabra, Joseph N; Gordon, Joshua L; Marquardt, Tamara L; Li, Zong-Ming

    2016-10-01

    The transverse carpal ligament (TCL) is a component of the flexor pulley system of the wrist, keeping the flexor tendons in place by resisting their volar displacement. The purpose of this study was to investigate the in vivo biomechanical interaction between the TCL and flexor tendons in response to tendon tensioning with the wrist at various postures. In eight healthy subjects, the flexor digitorum superficialis and profundus tendons were tensioned by isometrically applying loads (5, 10, and 15N) to the index finger while the wrist posture was at 20° extension, neutral, 20° flexion, and 40° flexion. The TCL and flexor tendons were imaged at the distal carpal tunnel cross section using ultrasound. The volar-dorsal positions of the tendons, TCL arch height, and TCL-tendon distances were calculated. With increasing wrist flexion, the flexor tendons moved volarly, the TCL arch height increased, and the TCL-tendon distances decreased, indicating that the flexor tendons contacted the TCL and pushed it volarly. The TCL-tendon interaction was amplified by the combination of finger loading and wrist flexion. This study provides in vivo evidence of the biomechanical interaction between the TCL and flexor tendons. Repetitive TCL-tendon interactions may implicate the interacting tissues and the median nerve resulting in tissue maladaptation and nerve compression.

  9. Flexor carpi ulnaris transplant and its use in cerebral palsy.

    PubMed

    GREEN, W T; BANKS, H H

    1962-10-01

    In our experience, transplantation of the flexor carpi ulnaris is the single best procedure to improve function of the wrist and hand in cerebral palsy. It aids dorsiflexion and supination and, at the same time, preserves active motion of the wrist. This is highly desirable since finger control may be seriously impaired in cerebral palsy and the additional motion provided at the wrist may be most helpful. In fact, since using this procedure we have found that fusion of the wrist is rarely indicated. A good result from a flexor carpi ulnaris transplant depends first upon the careful choice of the patient for the procedure.Requirements for the best function from the transplant include reasonable finger control preoperatively with passive flexibility of the hand, wrist, and forearm; stereognosis of the involved hand; reasonable intelligence; high motivation of the patient and family; and a thorough postoperative regimen.The difference between a good result and a poor result was often the thoroughness of the postoperative care. The value of both exercise and support for the part cannot be overemphasized nor can one underestimate the importance of the interest and ambitions of the patient and his family. The procedure should be postponed until the age when the individual may be expected to cooperate in the training of the transplant.

  10. Central fatigue affects plantar flexor strength after prolonged running.

    PubMed

    Saldanha, A; Nordlund Ekblom, M M; Thorstensson, A

    2008-06-01

    The primary aim of this study was to examine central fatigue of the plantar flexor muscle group after prolonged running using the twitch interpolation technique. Eight healthy, habitually active male subjects ran on a motorized treadmill for 2 h at a speed corresponding to 75% of peak oxygen uptake (VO(2peak)). Maximal voluntary isometric contraction (MVC) strength as well as the electrically induced twitch produced during MVC [interpolated twitch (IT)] and at rest [resting twitch (RT)] were measured before and after running. The level of activation (LOA) during each MVC was calculated as LOA (%)=100(1-IT/RT). Both MVC and LOA decreased (17+/-16% and 19+/-15%, respectively, P<0.05) after running, whereas RT did not change. The decrease in MVC was correlated with the decrease in LOA (r=0.87, P<0.05). The results demonstrate that after 2 h of treadmill running at an intensity of 75% of VO(2peak), there was a reduction in maximal voluntary plantar flexor muscle strength that was mainly related to central fatigue.

  11. Measurement of torque of trunk flexors at different velocities.

    PubMed

    Wessel, J; Ford, D; van Driesum, D

    1992-12-01

    The purpose of this study was to determine the test-retest reliability of recording isometric and isokinetic torque of the trunk flexors and to examine the effect of velocity on the torque curves. Thirty healthy subjects were tested on two occasions for isometric torque of trunk flexion at four angles and eccentric and concentric torque at three velocities. Two subjects repeated these tests in the passive mode to determine the torque produced by the trunk when there was no active flexion effort. Intraclass correlation coefficients were above 0.85 for all isometric and isokinetic measures. Standard errors of measurement ranged from 6.9 to 19.5 Nm. Student t-tests indicated no significant differences between occasions for all outcome measures. Examination of passive and active torque curves indicated that the torque produced by the mass of the trunk increased with increasing velocity. It is concluded that both isometric and isokinetic testing of the trunk flexors are reliable, but that testing at higher velocities may not provide a valid measure of muscle performance.

  12. Phenol block for hip flexor muscle spasticity under ultrasonic monitoring.

    PubMed

    Koyama, H; Murakami, K; Suzuki, T; Suzaki, K

    1992-11-01

    Hip flexor spasticity, which is often associated with central nervous system (CNS) diseases, is a major impediment in rehabilitation. In order to cope with this problem, lumbar nerve blocking techniques developed by Meelhuysen and major and minor psoas muscle blocking techniques developed by Awad have been used in combination with physical therapies. Based on these techniques, we conducted major and minor psoas muscle phenol block (motor point block or intramuscular nerve block) under ultrasonic monitoring. Phenol block was conducted in nine patients with cerebral infarction (13 blocking procedures) and three with spinal cord injuries (six blocking procedures) while keeping them in a lateral position with the operation side upside. The beginning of the femoral nerves and part of the lumbar artery were visualized by ultrasound in some patients. As a result of the improvement of hip flexor spasticity, the range of hip joint motion (determined by the Mundale technique, prone hip extension and Thomas test) improved shortly after blocking. When physical therapy was conducted after blocking, improvement of skin care management was observed in eight cases, ability to keep in a stable sitting position in nine, improvement of a standing posture in three, increases in the ability to walk in two and alleviation of pain in three. Although nerve block is reported to result in hematoma, decreases in muscle force, pain, cystic/rectal disorders and hypogonadism, we have observed no such complication in our patients.

  13. Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump

    PubMed Central

    Yun, Sung Joon; Kim, Moon-Hwan; Weon, Jong-Hyuck; Kim, Young; Jung, Sung-Hoon; Kwon, Oh-Yun

    2016-01-01

    [Purpose] This study assessed the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Subjects and Methods] Eighteen healthy volunteers participated in the study. Each participant completed tests for peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Results] The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance. [Conclusion] These findings indicate that the measurement of peak first toe flexor muscle strength and ankle dorsiflexion range of motion may be useful in clinical practice for improving jump performance in athletes training for sports such as volleyball and basketball. PMID:27630405

  14. A biomechanical study of the flexor digitorum superficialis: effects of digital pulley excision and loss of the flexor digitorum profundus.

    PubMed

    Hamman, J; Ali, A; Phillips, C; Cunningham, B; Mass, D P

    1997-03-01

    Many reports have been devoted to characterizing the significance of the pulleys for the flexor digitorum profundus (FDP). However, no comparable work has been published on the flexor digitorum superficialis (FDS). This study characterized the FDS in a human cadaver model. Eleven fresh-frozen cadaver hands were used. By using a tensiometer, data were gathered for tendon excursion, tendon load, and work of flexion. Changes in efficiency were caused by excision of annular pulleys A1, A2, A3, and the palmar aponeurotic pulley. We also measured the effect of FDP excision on FDS efficiency. Sectioning of the A2 and A3 pulleys together caused statistically significant losses of efficiency in all three parameters (work, load, and excursion). When the FDP was removed from a finger with an intact pulley system, losses in both work and excursion efficiencies were significant. Removing the FDP while cutting different pulleys caused significant decrease in FDS excursion efficiency. We conclude that A2 and A3 are the most important pulleys for maintaining normal FDS function, and that the presence of the FDP in the digital sheath is essential for optimal FDS excursion efficiency.

  15. Resistance exercise prevents plantar flexor deconditioning during bed rest

    NASA Technical Reports Server (NTRS)

    Bamman, M. M.; Hunter, G. R.; Stevens, B. R.; Guilliams, M. E.; Greenisen, M. C.

    1997-01-01

    Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional

  16. Resistance exercise prevents plantar flexor deconditioning during bed rest

    NASA Technical Reports Server (NTRS)

    Bamman, M. M.; Hunter, G. R.; Stevens, B. R.; Guilliams, M. E.; Greenisen, M. C.

    1997-01-01

    Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional

  17. Determining flexor-tendon repair techniques via soft computing

    NASA Technical Reports Server (NTRS)

    Johnson, M.; Firoozbakhsh, K.; Moniem, M.; Jamshidi, M.

    2001-01-01

    An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.

  18. Determining flexor-tendon repair techniques via soft computing

    NASA Technical Reports Server (NTRS)

    Johnson, M.; Firoozbakhsh, K.; Moniem, M.; Jamshidi, M.

    2001-01-01

    An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.

  19. Flexor Tendon Sheath Engineering Using Decellularized Porcine Pericardium.

    PubMed

    Megerle, Kai; Woon, Colin; Kraus, Armin; Raghavan, Shyam; Pham, Hung; Chang, James

    2016-10-01

    The flexor tendon sheath is an ideal target for tissue engineering because it is difficult to reconstruct by conventional surgical methods. The authors hypothesized that decellularized porcine pericardium can be used as a scaffold for engineering a biologically active tendon sheath. The authors' protocol removed cellular material from the pericardium and preserved the structural architecture in addition to the collagen and glycosaminoglycan content. The scaffold was successfully reseeded with human sheath synoviocytes and human adipose-derived stem cells. Cells were evaluated for 8 weeks after reseeding. The reseeded construct demonstrated continuous production of hyaluronic acid, the main component of synovial fluid. After being seeded on the membrane, adipose-derived stem cells demonstrated down-regulation of collagen I and III and up-regulation of hyaluronan synthase 2. The results indicate that decellularized porcine pericardium may be a potential scaffold for engineering a biologically active human tendon sheath.

  20. Effects of apomorphine on flexor reflex and periodic limb movement.

    PubMed

    Paradiso, Guillermo; Khan, Farooq; Chen, Robert

    2002-05-01

    It has been suggested that periodic leg movements (PLM) and spinal flexor reflex (FR) share common mechanisms. Although dopaminergic agents improve PLM in humans and strongly influence spinal FR circuitry in animal studies, its effects on FR have not been documented in humans. We describe a 65-year-old man with PLM after overnight withdrawal of dopaminergic agents. The electromyographic pattern of spontaneous PLM closely resembled that of the FR elicited by medial plantar nerve stimulation. Thirty minutes after subcutaneous injection of apomorphine, both PLM and FR were completely abolished. These findings demonstrate that dopaminergic agents can suppress exaggerated FR in humans, and support the hypothesis of common mechanisms for PLM and FR.

  1. Digital flexor musculotendinous contracture in two Devon Rex cats.

    PubMed

    Thom, Leonie K; Pool, Roy R; Malik, Richard

    2017-03-01

    Clinical summary: A 13-year-old, spayed Devon Rex with unilateral digital flexor musculotendinous contracture of the forelimb was treated by surgical tenotomy. The condition improved transiently, but recurred rapidly and became bilateral. Histopathologic analysis of necropsy tissues resulted in a morphologic diagnosis of fibromyositis of the antebrachial muscles causing contracture and flexural deformity of the carpi and phalanges of both thoracic limbs. A search for similar cases yielded the clinical notes of a second cat, a 10-year-old, spayed Devon Rex, also with bilateral disease. This second case responded well to surgical tenotomy but tissue biopsies were not obtained to permit microscopic assessment of the underlying pathologic process. Relevance and novel information: Acquired and permanent contracture of the digital flexor muscles and/or tendons of the forelimbs is a rare and poorly described condition of cats. The very limited number of documented cases describing disease affecting one or more digits (but not the carpus) infers a causal link with onychectomy, but reported histopathologic changes have been limited to the tendons. The two cases described in this report suffered contracture of the carpus and all digits bilaterally, one without previous onychectomy and the other 9 years after onychectomy. There were novel histopathologic findings in the muscles of the one case for which biopsy material was available. Information gained from these two cases provides a new perspective for the investigation and treatment of future cases. Specifically, consideration should be given to an underlying immune-mediated myopathic process and a possible genetic predisposition in the Devon Rex breed. Currently, the poorly understood etiopathogenesis hinders our ability to definitively recommend treatment options, which might include corticosteroids and other forms of immunosuppressive therapy.

  2. Sporadic Inclusion Body Myositis Manifesting as Isolated Muscle Weakness of the Finger Flexors Three Years after Disease Onset

    PubMed Central

    Suwa, Yuichi; Suzuki, Naoki; Soga, Temma; Harada, Ryuhei; Shibui, Aya; Kuroda, Hiroshi; Izumi, Rumiko; Tateyama, Maki; Nakashima, Ichiro; Sonoo, Masahiro; Aoki, Masashi

    2016-01-01

    Sporadic inclusion body myositis (sIBM) is a chronic progressive myopathy characterized by muscle weakness of both the quadriceps femoris and finger flexors. We herein present the case of a typical male patient with sIBM, which manifested as the isolated weakness of the finger flexors three years after the disease onset. We have identified several patients with sIBM in our cohort with muscle weakness of the flexors but not the quadriceps femoris. Examination of the flexor digitorum profundus muscle is important for the early and proper diagnosis of sIBM, even if a patient only presents with isolated finger flexor muscle weakness. PMID:27904121

  3. Increase in flexor but not extensor corticospinal motor outputs following ischemic nerve block.

    PubMed

    Vallence, Ann-Maree; Hammond, Geoffrey R; Reilly, Karen T

    2012-06-01

    Human motor cortex is capable of rapid and long-lasting reorganization, evident globally, as shifts in body part representations, and at the level of individual muscles as changes in corticospinal excitability. Representational shifts provide an overview of how various body parts reorganize relative to each other but do not tell us whether all muscles in a given body part reorganize in the same manner and to the same extent. Transcranial magnetic stimulation (TMS) provides information about individual muscles and can therefore inform us about the uniformity of plastic changes within a body part. We used TMS to investigate changes in corticospinal excitability of forearm flexors and extensors after inflation of a tourniquet around the wrist. Motor evoked potential (MEP) amplitudes and input/output (I/O) curves were obtained from wrist flexors and extensors simultaneously before and during block. TMS was delivered to the optimal site for eliciting MEPs in flexors in experiment 1, extensors in experiment 2, and both flexors and extensors in experiment 3. In all experiments flexor MEP amplitude increased during block while extensor MEP amplitude showed no systematic change, and the slope of flexor but not extensor I/O curves increased. Flexor H-reflex amplitude normalized to maximal M wave showed negligible changes during block, suggesting that the increase in corticospinal excitability in the flexors cannot be completely explained by increased excitability at the spinal cord level. These findings show that forearm flexors and extensors differ in their potential for plastic changes, highlight the importance of investigating how experimentally induced plasticity affects anatomically close, but functionally distinct, muscle groups, and suggest that rehabilitation interventions aiming to alter cortical organization should consider the differential sensitivity of various muscle groups to plasticity processes.

  4. The effect of baclofen on the hind limb flexor reflex of the spinal rat.

    PubMed

    Sypniewska, M

    1979-01-01

    The effect of baclofen on the hind limb flexor reflex of the spinal rat was studied. Baclofen inhibited the flexor reflex, this effect not being antagonized by picrotoxin and bicuculline. Baclofen reduced the stimulating action of quipazine and LSD, had no effect on the clonidine-induced reflex stimulation, but inhibited the flexor reflex stimulation induced by amphetamine and fenfluramine. The results obtained bring forth some doubts as to the GABA-mimetic action of baclofen. The action of baclofen on the spinal cord seems to be directed mainly to the presynaptic part of the noradrenergic and serotonergic systems.

  5. Bilateral Tensor Fasciae Suralis Muscles in a Cadaver with Unilateral Accessory Flexor Digitorum Longus Muscle

    PubMed Central

    Herrin, Sean O.

    2017-01-01

    Muscle variants are routinely encountered in the dissection laboratory and in clinical practice and therefore anatomists and clinicians need to be aware of their existence. Here we describe two different accessory muscles identified while performing educational dissection of a 51-year-old male cadaver. Tensor fasciae suralis, a rare muscle variant, was identified bilaterally and accessory flexor digitorum longus, a more common muscle variant, was present unilaterally. Tensor fasciae suralis and accessory flexor digitorum longus are clinically relevant muscle variants. To our knowledge, the coexistence of tensor fasciae suralis and accessory flexor digitorum longus in the same individual has not been reported in either cadaveric or imaging studies. PMID:28210274

  6. Flexor Hallucis Longus Tenosynovitis and First Metatarsophalangeal Synovitis After Penetrating Nail Prick Injury: Treated by Zone 3 Flexor Hallucis Longus Tendoscopy and Metatarsosesamoid Arthroscopy.

    PubMed

    Lui, Tun Hing

    2017-04-01

    Pedal penetrating nail prick injury around the first metatarsal head can result in persistent synovitis of the first metatarsophalangeal joint and tenosynovitis of the flexor hallucis longus tendon. Exploration and debridement is indicated if the condition does not improve with antibiotics. Open surgery requires extensive dorsal and plantar incisions. The purpose of this Technical Note is to report the combined arthroscopic and tendoscopic approaches to address the first metatarsophalangeal joint and flexor hallucis longus tendon pathologies. Because it is a result of a pedal injury, the layer-by-layer exploration and debridement is from plantar dorsally. It starts with zone 3 flexor hallucis longus tendoscopy, followed by arthroscopy of the metatarsosesamoid compartment, and finally arthroscopy of the metatarsophalangeal compartment.

  7. Effect of strength training on regional hypertrophy of the elbow flexor muscles.

    PubMed

    Drummond, Marcos D M; Szmuchrowski, Leszek A; Goulart, Karine N O; Couto, Bruno P

    2016-10-01

    Muscle hypertrophy is the main structural adaptation to strength training. We investigated the chronic effects of strength training on muscle hypertrophy in different regions of the elbow flexor muscles. Eleven untrained men (21.8 ± 1.62 years) underwent magnetic resonance imaging to determine the proximal, medial, distal, and mean cross-sectional areas (CSA) of the elbow flexors. The volunteers completed 12 weeks of strength training. The training protocol consisted of 4 sets of 8-10 maximum repetitions of unilateral elbow flexion. The interval between sets was 120 s. The training frequency was 3 sessions per week. The magnetic resonance images verified the presence of significant and similar hypertrophy in the distal, medial, and proximal portions of the elbow flexor muscles. Muscle hypertrophy may be assessed using only the medial CSA. We should not expect different degrees of hypertrophy among the regions of the elbow flexor muscles. Muscle Nerve 54: 750-755, 2016. © 2016 Wiley Periodicals, Inc.

  8. Correlation between neck slope angle and deep cervical flexor muscle thickness in healthy participants.

    PubMed

    Ishida, Hiroshi; Suehiro, Tadanobu; Kurozumi, Chiharu; Ono, Koji; Ando, Suguru; Watanabe, Susumu

    2015-10-01

    The purpose of this study was to clarify the correlation between neck slope angle and deep cervical flexor muscle thickness in healthy subjects. Forty-two healthy male (20.7 ± 2.6 years old) participated in this study. Neck slope angle was measured in a relaxed sitting posture. The deep cervical flexor muscle thickness was measured in a relaxed supine posture. The correlations between neck slope angle and normalized muscle thickness relative to body mass index were determined using Pearson's correlation coefficient. There was a moderate positive correlation between neck slope angle and normalized muscle thickness (r = 0.414, P = 0.006). The result demonstrated that participants with lower neck slope angles had smaller muscle thicknesses of the deep cervical flexor muscles. It appears that the deep cervical flexor muscle thickness might be associated with neck slope angle in a relaxed sitting posture. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Separate Belly and Tendon of Flexor Digitorum Superficialis to the Fifth Digit

    PubMed Central

    Rao, Mohandas; Somayaji, S Nagabhushana; Mishra, Snigdha; Guru, Anitha; Rao, Ashutosh

    2011-01-01

    Variation in the origin of long flexor tendons in the anterior compartment of forearm is common. During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus), we observed a separate muscle belly and tendon of flexor digitorum superficialis (FDS) to the fifth digit in the right upper limb of a 60 year-old male cadaver. The anomalous muscle belly originated from the common flexor tendon from the medial epicondyle of the humerus and continued as a thin tendon at the middle of the forearm to get inserted into the middle phalanx of the fifth digit. This can be considered as a case of split flexor digitorum superficialis. Such muscle variations and knowledge of their frequency, appearance, and location can be helpful for surgeons. PMID:28861181

  10. Separate Belly and Tendon of Flexor Digitorum Superficialis to the Fifth Digit.

    PubMed

    Rao, Mohandas; Somayaji, S Nagabhushana; Mishra, Snigdha; Guru, Anitha; Rao, Ashutosh

    2011-11-01

    Variation in the origin of long flexor tendons in the anterior compartment of forearm is common. During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus), we observed a separate muscle belly and tendon of flexor digitorum superficialis (FDS) to the fifth digit in the right upper limb of a 60 year-old male cadaver. The anomalous muscle belly originated from the common flexor tendon from the medial epicondyle of the humerus and continued as a thin tendon at the middle of the forearm to get inserted into the middle phalanx of the fifth digit. This can be considered as a case of split flexor digitorum superficialis. Such muscle variations and knowledge of their frequency, appearance, and location can be helpful for surgeons.

  11. Partial anterior interosseous nerve palsy: isolated neuropraxia of the branch to flexor pollicis longus.

    PubMed

    Haflah, Nor Hazla Mohamed; Rashid, Abdul Halim Abd; Sapuan, Jamari

    2010-01-01

    Anterior interosseous nerve palsy is rare. Isolated neuropraxia of its branch to the flexor pollicis longus is even rarer. We present a case of a 24-year-old man who presented with weakness of his left thumb flexion after sustaining closed fracture of the proximal third of his left radius. On exploration, the anterior interosseous nerve and its branches was found to be intact as was the flexor pollicis longus. Electrophysiological studies demonstrated acute left anterior interosseous nerve neuropathy. Electromyography showed discrete motor unit at the flexor pollicis longus. Two months later the patient had full recovery of the flexor pollicis longus. We would like to highlight this rare occurrence and present a detailed history of this case to increase awareness amongst clinicians regarding this condition.

  12. Closed rupture of the flexor tendons caused by carpal bone and joint disorders.

    PubMed

    Yamazaki, H; Kato, H; Hata, Y; Nakatsuchi, Y; Tsuchikane, A

    2007-12-01

    We analysed 21 patients with closed rupture of the flexor tendons caused by carpal bone and joint disorders. The tendon that ruptured depended on the location of the bone perforation into the carpal tunnel. Radiocarpal arthrography was performed in 13 patients and capsular perforation was demonstrated by contrast medium leakage into the carpal canal in 11 patients. This proved a useful diagnostic test. The flexor tendon(s) were reconstructed with free tendon graft in 17 patients, cross-over transfer of flexor tendons from adjacent digits in two and buddying to an adjacent flexor tendon in one patient. Postoperative total active range of motion in the fingers after 13 free tendon graft reconstructions averaged 213 degrees (range 170-265 degrees ). The active range of motion of the thumb-interphalangeal joint after free tendon graft reconstruction in three cases improved from 0 degrees to 33 degrees on average (range 10 degrees -40 degrees ).

  13. Os trigonum syndrome with flexor hallucis longus tenosynovitis in a professional football referee.

    PubMed

    Cooper, M E; Wolin, P M

    1999-07-01

    The presentation of posterior ankle pain in any patient poses a diagnostic dilemma. The os trigonum syndrome and flexor hallucis longus stenosing tenosynovitis have been reported to occur in professional and amateur ballet dancers. It is important to consider these diagnoses in a patient who is not a dancer, as is shown in the case presented here. The patient in this case is a professional referee who injured his ankle while working on artificial turf. The treatment for os trigonum syndrome and flexor hallucis longus tenosynovitis is initially conservative, but in refractory cases, surgical removal of the os and release of the flexor hallucis longus tendon can be successfully performed. This is the first reported case of os trigonum syndrome and flexor hallucis longus tenosynovitis presenting simultaneously in a patient who is not a dancer.

  14. Tenosynovial Osteochondromatosis of the Flexor Hallucis Longus Tendon Treated by Tendoscopy.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Tendosynovial chondromatosis of the foot and ankle is a rare disease entity. We reported 3 patients with tenosynovial osteochondromatosis of flexor hallucis longus. They were successfully treated by arthroscopic synovectomy and removal of the loose bodies.

  15. Spontaneous flexor tendon rupture in systemic lupus erythematosus: A case report.

    PubMed

    Oda, Ryo; Fujiwara, Hiroyoshi; Tokunaga, Daisaku; Kishida, Aiko; Taniguchi, Daigo; Seno, Takahiro; Kawahito, Yutaka; Kubo, Toshikazu

    2016-09-01

    Spontaneous flexor tendon rupture is an unusual complication of systemic lupus erythematosus (SLE) and has not previously been reported. While tendon ruptures in association with SLE have been focused on the previous studies, upper extremity tendon ruptures are infrequently reported in the literature. Here, we present an uncommon case of spontaneous flexor tendon rupture of the ring and little fingers in a patient with SLE and discuss the mechanism of injury and its surgical treatment.

  16. DYNAMIC SONOGRAPHY OF THE EQUINE METACARPO(TARSO)PHALANGEAL DIGITAL FLEXOR TENDON SHEATH.

    PubMed

    DiGiovanni, Daria L; Rademacher, Nathalie; Riggs, Laura M; Baumruck, Rebecca A; Gaschen, Lorrie

    2016-11-01

    Palmar/plantar annular desmitis is a common disease that may be associated with adhesions and structures affecting the flexor tendons, which requires tenoscopy to diagnose. The purpose of this descriptive study was to develop a dynamic sonographic technique for evaluating the motion of normal equine flexor tendons in relation to the palmar/plantar annular ligament and to compare findings with horses previously diagnosed with palmar/plantar annular desmitis. Ten healthy adult horses were examined prospectively and the images of four horses diagnosed with palmar/plantar annular desmitis were retrospectively evaluated. Dynamic sonography was performed at the level of the metacarpo/metatarsophalangeal joint by maximally extending and flexing the interphalangeal joints. Palmar/plantar annular ligament thickness (mm), size of any gap between the flexor tendons, and subjectively increased angulation of the long linear echoes of the superficial digital flexor tendon were measured. The presence of gliding motion between the palmar/plantar annular ligament and superficial digital flexor tendon was determined by consensus. Twenty-eight healthy control limbs (16 hind/12 fore) and four with palmar/plantar annular desmitis (3 hind/1 fore) were evaluated. Controls had unrestricted gliding motion between the palmar/plantar annular ligament and flexor tendons and zero to 13° of angulation of the long linear echoes. The four affected horses had restricted gliding motion and between 20-35° angulation of the long linear echoes. Dynamic ultrasound is a feasible technique for detecting restricted flexor tendon and palmar/plantar annular ligament gliding motion, as well as subjectively increased angulation of the long linear echoes of the flexor tendon in affected horses compared with controls and warrants further investigation.

  17. Complications of common hand and wrist surgery procedures: flexor and extensor tendon surgery.

    PubMed

    Fischer, Lauren H; Abzug, Joshua M; Osterman, A Lee; Stern, Peter J; Chang, James

    2014-01-01

    Orthopaedic and hand surgeons frequently treat disorders of the flexor and extensor tendon systems. Common conditions, such as trigger finger, de Quervain tenosynovitis, extensor tendon injury, and zone II flexor tendon injury, can be challenging to treat. Complications that limit normal hand function still occur despite advances in surgical techniques and therapy protocols. It is helpful to be aware of the complications related to the treatment of these hand disorders and understand surgical techniques to minimize their frequency.

  18. Endoscopic Loose Body Removal From Zone 2 Flexor Hallucis Longus Tendon Sheath.

    PubMed

    Lui, Tun Hing

    2016-06-01

    Tenosynovial chondromatosis can occur in the flexor hallucis longus tendon sheath. Complete synovectomy and removal of the loose bodies comprise the treatment of choice. An open procedure requires extensive soft-tissue dissection because the flexor hallucis longus tendon is a deep structure except at the hallux. A tendoscopy approach to synovectomy and removal of loose bodies has the advantage of minimally invasive surgery. This technical note outlines pearls and pitfalls and provides a step-by-step guide to performing this procedure.

  19. A probabilistic finger biodynamic model better depicts the roles of the flexors during unloaded flexion.

    PubMed

    Li, Kang; Zhang, Xudong

    2010-09-17

    Previous deterministic finger biomechanical models predicted that the flexor digitorum superficialis (FDS) was silent and the flexor digitorum profundus (FDP) was the only active flexor during finger flexion. Experimental studies in vivo, however, recorded activities of both flexors. In this study, in an attempt to elucidate the roles of the flexors, a probabilistic biodynamic model of the index finger was constructed to estimate the muscle-tendon forces during an experimentally measured index finger flexion movement. A Monte-Carlo simulation was performed with four model parameters, including moment arms, physiological cross sectional areas (PCSA), passive torques, and anthropometric measures as independent random variables. The muscle-tendon forces at each time point were determined using a nonlinear optimization technique. The model predicted that both FDS and FDP contributed to sustaining the movement and the FDS was not necessarily silent. The two distinct force patterns observed in vivo in experimental studies were also corroborated by the simulation. These findings, contrary to previous deterministic models' predictions but in agreement with experimental measurements, explained the observed coactivation of FDS and FDP, and resolved the controversy regarding the roles of the flexors in finger movement dynamics.

  20. Single-stage reconstruction of flexor tendons with vascularized tendon transfers.

    PubMed

    Cavadas, P C; Pérez-García, A; Thione, A; Lorca-García, C

    2015-03-01

    The reconstruction of finger flexor tendons with vascularized flexor digitorum superficialis (FDS) tendon grafts (flaps) based on the ulnar vessels as a single stage is not a popular technique. We reviewed 40 flexor tendon reconstructions (four flexor pollicis longus and 36 finger flexors) with vascularized FDS tendon grafts in 38 consecutive patients. The donor tendons were transferred based on the ulnar vessels as a single-stage procedure (37 pedicled flaps, three free flaps). Four patients required composite tendon and skin island transfer. Minimum follow-up was 12 months, and functional results were evaluated using a total active range of motion score. Multiple linear regression analysis was performed to evaluate the factors that could be associated with the postoperative total active range of motion. The average postoperative total active range of motion (excluding the thumbs) was 178.05° (SD 50°). The total active range of motion was significantly lower for patients who were reconstructed with free flaps and for those who required composite tendon and skin island flap. Age, right or left hand, donor/motor tendon and pulley reconstruction had no linear effect on total active range of motion. Overall results were comparable with a published series on staged tendon grafting but with a lower complication rate. Vascularized pedicled tendon grafts/flaps are useful in the reconstruction of defects of finger flexor tendons in a single stage, although its role in the reconstructive armamentarium remains to be clearly established.

  1. Metabolic demand and muscle damage induced by eccentric cycling of knee extensor and flexor muscles.

    PubMed

    Peñailillo, Luis; Guzmán, Nicolás; Cangas, José; Reyes, Alvaro; Zbinden-Foncea, Hermann

    2017-03-01

    The aim of this study was to examine the metabolic demand and extent of muscle damage of eccentric cycling targeting knee flexor (FLEX) and knee extensor (EXT) muscles. Eight sedentary men (23.3 ± 0.7 y) underwent two eccentric cycling sessions (EXT and FLEX) of 30 min each, at 60% of the maximum power output. Oxygen consumption (VO2), heart rate (HR) and rated perceived exertion (RPE) were measured during cycling. Countermovement and squat jumps (CMJ and SJ), muscle flexibility, muscle soreness and pain pressure threshold (PPT) of knee extensor and flexor muscles were measured before, immediately after and 1-4 days after cycling. FLEX showed greater VO2 (+23%), HR (+14%) and RPE (+18%) than EXT. CMJ and SJ performance decreased similarly after cycling. Muscle soreness increased more after EXT than FLEX and PPT decreased in knee extensor muscles after EXT and decreased in knee flexor muscles after FLEX. Greater loss of muscle flexibility in knee flexor muscles after FLEX was observed. Eccentric cycling of knee flexor muscles is metabolically more demanding than that of knee extensors, however muscle damage induced is similar. Knee flexors experienced greater loss of muscle flexibility possibly due to increased muscle stiffness following eccentric contractions.

  2. Simultaneous Knee Extensor Muscle Action Induces an Increase in Voluntary Force Generation of Plantar Flexor Muscles.

    PubMed

    Suzuki, Takahito; Shioda, Kohei; Kinugasa, Ryuta; Fukashiro, Senshi

    2017-02-01

    Suzuki, T, Shioda, K, Kinugasa, R, and Fukashiro, S. Simultaneous knee extensor muscle action induces an increase in voluntary force generation of plantar flexor muscles. J Strength Cond Res 31(2): 365-371, 2017-Maximum activation of the plantar flexor muscles is required for various sporting activities that involve simultaneous plantar flexion and knee extension. During a multi-joint movement, activation of the plantar flexor muscles is affected by the activity of the knee extensor muscles. We hypothesized that coactivation of the plantar flexor muscles and knee extensor muscles would result in a higher plantar flexion torque. To test this hypothesis, 8 male volunteers performed maximum voluntary isometric action of the plantar flexor muscles with and without isometric action of the knee extensor muscles. Surface electromyographic data were collected from 8 muscles of the right lower limb. Voluntary activation of the triceps surae muscles, evaluated using the interpolated twitch technique, significantly increased by 6.4 percentage points with intentional knee extensor action (p = 0.0491). This finding is in line with a significant increase in the average rectified value of the electromyographic activity of the vastus lateralis, fibularis longus, and soleus muscles (p = 0.013, 0.010, and 0.045, respectively). The resultant plantar flexion torque also significantly increased by 11.5% of the predetermined maximum (p = 0.031). These results suggest that higher plantar flexor activation coupled with knee extensor activation facilitates force generation during a multi-joint task.

  3. Intramuscular EMG from the hip flexor muscles during human locomotion.

    PubMed

    Andersson, E A; Nilsson, J; Thorstensson, A

    1997-11-01

    The purpose was to investigate the activation pattern of five major hip flexor muscles and its adaptation to changing speed and mode of progression. A total of 11 healthy subjects performed walking and running on a motor-driven treadmill at speeds ranging from 1.0 to 6.0 m s-1. Intramuscular fine-wire electrodes were used to record myoelectric signals from the iliacus, psoas, sartorius, rectus femoris and tensor fascia latae muscles. The basic pattern, with respect to number of activation periods, remained the same irrespective of speed and mode of progression. However, differences in the relative duration and timing of onset of activation occurred between individual muscles. Over the speed range in walking, a progressively earlier onset was generally seen for the activation period related to hip flexion. Changes in EMG amplitude were measured in the iliacus and psoas muscles and showed a marked increase and difference between walking and running at speeds above 2.0 m s-1. Thus, the alternating flexion-extension movements at the hip during locomotion appear to be governed by a rather fixed 'neural program' which normally only needs minor modulations to accomplish the adjustments accompanying an increase in speed of progression as well as a change from walking to running.

  4. DAS User Manual

    NASA Astrophysics Data System (ADS)

    Østensen, Roy

    2008-10-01

    The HELAS Database for AsteroSeismology (DAS) is one of the deliverables of the Work Package NA5: Asteroseismology of the European Coordination Action in Helio- and Asteroseismology (HELAS). The DAS aims to provide easy access to publicly available asteroseismological timeseries data, both photometric and spectroscopic. In particular, the DAS and the HELAS software package FAMIAS are ideally suited to train Master and PhD students in asteroseismic data analysis and to build longterm datasets. The number of stars in the system is still limited and reflects the willingness of data owners to provide their data after publication. Work continues to populate the database with contributions from the community, and at present the number of stars in the database is 82

  5. Friction between finger flexor tendons and the pulley system in the crimp grip position.

    PubMed

    Moor, Beat K; Nagy, Ladislav; Snedeker, Jess G; Schweizer, Andreas

    2009-01-01

    Disruption of the finger flexor tendon pulleys are the most often occurring injury in rock climbers due to bowstringing of tendons during crimp grip position. The aim of this study was to quantify friction between the flexor tendons and pulleys and the influence of high load and speed of movement as a potential factor of pulley disruption. Friction between the flexor tendons and pulleys of eight human cadaver fingers was indirectly determined using an isokinetic movement device. During flexion and extension movement with rotational speed from 30 to 210 deg/s in the proximal interphalangeal joint and with load from 20 to 100 N to the flexor tendons the flexion force at the tip of the finger was measured. With 40 N loaded flexor tendons the force at the fingertip was 14.5 N (SD1.5) during extension and 12.6N (SD1.3) during flexion movement. Corresponding force difference of 12.9% and 3.77 N (SD0.6) force of friction can be calculated. Friction peaked at 85.8 degrees (SD2.05) of flexion of the proximal interphalangeal joint. Different speed of motion and load to the flexor tendons did not influence force difference other than linear. Considerable friction between flexor tendons and pulleys is apparent and therefore may have an influence on pulley injuries. Particularly during the crimp grip position where the proximal interphalangeal joint is flexed about 90 degrees shows the greatest amount of friction. However there was no change of friction during high speed motion and no other than linear increase during high load.

  6. Plantar flexor moment arm and muscle volume predict torque-generating capacity in young men.

    PubMed

    Baxter, Josh R; Piazza, Stephen J

    2014-03-01

    Muscle volume is known to correlate with maximal joint torque in humans, but the role of muscle moment arm in determining maximal torque is less clear. Moderate correlations have been reported between maximal isometric knee extensor torque and knee extensor moment arm, but no such observations have been made for the ankle joint. It has been suggested that smaller muscle moment arms may enhance force generation at high rates of joint rotation, but this has not yet been observed for ankle muscles in vivo. The purpose of the present study was to correlate plantar flexor moment arm and plantar flexor muscle volume with maximal plantar flexor torque measured at different rates of plantar flexion. Magnetic resonance imaging was used to quantify the plantar flexor moment arm and muscle volume of the posterior compartment in 20 healthy young men. Maximal plantar flexor torque was measured isometrically and at three plantar flexion speeds using an isokinetic dynamometer. Plantar flexor torque was significantly correlated with muscle volume (0.222 < R(2) < 0.322) and with muscle moment arm at each speed (0.323 < R(2) < 0.494). While muscle volume was strongly correlated with body mass and stature, moment arm was not. The slope of the torque-moment arm regression line decreased as the rate of joint rotation increased, indicating that subjects with small moment arms experienced smaller reductions in torque at high speeds. The findings of this study suggest that plantar flexor moment arm is a determinant of joint strength that is at least as important as muscle size.

  7. The effect of transcutaneous electrical nerve stimulation on postural sway on fatigued dorsi-plantar flexor.

    PubMed

    Yu, JaeHo; Lee, SoYeon; Kim, HyongJo; Seo, DongKwon; Hong, JiHeon; Lee, DongYeop

    2014-01-01

    The application of transcutaneous electrical nerve stimulation (TENS) enhances muscle weakness and static balance by muscle fatigue. It was said that TENS affects decrease of the postural sway. On the other hand, the applications of TENS to separate dorsi-plantar flexor and the comparison with and without visual input have not been studied. Thus, the aim of this study was to compare the effects of TENS on fatigued dorsi-plantar flexor with and without visual input. 13 healthy adult males and 12 females were recruited and agreed to participate as the subject (mean age 20.5 ± 1.4, total 25) in this study after a preliminary research. This experiment was a single group repeated measurements design in three days. The first day, after exercise-induced fatigue, the standing position was maintained for 30 minutes and then the postural sway was measured on eyes open(EO) and eyes closed(EC). The second, TENS was applied to dorsi flexor in standing position for 30 minutes after conducting exercise-induced fatigue. On the last day, plantar flexor applied by TENS was measured to the postural sway on EO and EC after same exercise-induced fatigue. The visual input was not statistically difference between the groups. However, when compared of dorsi-plantar flexor after applied to TENS without visual input, the postural sway of plantar flexor was lower than the dorsi flexor (p< 0.05). As the result, the application of TENS in GCM clinically decreases the postural sway with visual input it helps to stable posture control and prevent to falling down.

  8. Nonseptic tenosynovitis of the digital flexor tendon sheath caused by longitudinal tears in the digital flexor tendons: a retrospective study of 135 tenoscopic procedures.

    PubMed

    Arensburg, L; Wilderjans, H; Simon, O; Dewulf, J; Boussauw, B

    2011-11-01

    Longitudinal tears (LTs) of the digital flexor tendons are an important cause of chronic tenosynovitis of the digital flexor tendon sheath (DFTS). The origin of those marginal tears is not yet fully understood. The long-term outcome after medical and surgical treatment is guarded. To determine the prevalence of LTs of the digital flexor tendons in a large population of horses undergoing diagnostic tenoscopy of the DFTS and to assess the outcome of surgical treatment and the factors influencing the outcome. Medical records of 130 horses with chronic tenosynovitis of the DFTS that had tenoscopic surgery between 1999 and 2009 were evaluated. One hundred and thirty-five DFTSs were examined. LTs were diagnosed in 104 DFTSs in 101 horses and long-term follow-up was obtained. Seventy-eight percent of the horses with a nonseptic tenosynovitis of the DFTS had a LT. Preoperative ultrasonographic examination diagnosed tears in 76% of the cases. In showjumpers forelimbs were more frequently affected than hindlimbs (88 vs. 12%), with the right front having a higher incidence of injury than the left front (76 vs. 24%). Seventy-nine percent of the tears involved the deep digital flexor tendon (DDFT) and 87% were located on the lateral tendon border. Thirty-seven horses (38%) returned to an equal or higher level of work. The use of a radiofrequency probe (coblation) was associated with a lower level of performance and decreased the cosmetic end result. Persistence of marked post operative distension of the DFTS carried a poor prognosis for return to previous level of work. A guarded prognosis for future soundness should be given to horses presented for treatment of LTs of the digital flexor tendons. The use of coblation wands had a negative effect on the final outcome. © 2010 EVJ Ltd.

  9. Flexor hallucis longus tendon transfer in treatment of Achilles tendinosis.

    PubMed

    Schon, Lew C; Shores, Jennifer L; Faro, Frances D; Vora, Anand M; Camire, Lyn M; Guyton, Gregory P

    2013-01-02

    In patients with Achilles tendinosis, Achilles tendon debridement can be supplemented with flexor hallucis longus tendon transfer. Outcomes have not been studied prospectively in older, sedentary, and overweight patients. Fifty-eight consecutive limbs in fifty-six consecutive older, sedentary patients with insertional or midsubstance Achilles tendinosis were enrolled prospectively and underwent the procedure. Ten patients were lost to follow-up, leaving forty-eight limbs in forty-six patients available for evaluation after twenty-four months. The forty-six patients who were included in the study had an average age of 54 ± 10 years with an average body mass index of 33.8 ± 6.8 kg/m². Significant improvement was observed between baseline and twenty-four months in terms of the visual analog scale for overall pain intensity (6.7 ± 2.3 versus 0.8 ± 2.0; p < 0.001), the Short Form-36 physical score (34.3 ± 8.0 versus 49.0 ± 9.3; p < 0.001), the Ankle Osteoarthritis Scale pain (54.4 ± 19.2 versus 1.9 ± 2.7; p < 0.001) and dysfunction (62.6 ± 21.4 versus 11.0 ± 24.2; p < 0.001) subscale scores, and performance of a single-leg heel rise (1.9 ± 3.0 versus 7.3 ± 2.7 cm; p < 0.001). Significant improvement compared with baseline was observed at three or six months except in the single-leg heel rise. Improvements in terms of pain and function occurred over twenty-four months, with the most improvement occurring in the first twelve months. At twenty-four months, maximum gastrocnemius circumference was significantly less in the involved compared with the uninvolved leg (40.2 ± 5.1 versus 41.2 ± 4.8 cm; p < 0.001). The mean passive range of motion of the first metatarsophalangeal joint decreased from 85.1° ± 25.3° preoperatively to 68.1° ± 36.7° (a 20% change) at six months (p = 0.03). Most patients reported no hallux weakness (57%; twenty-six of forty-six patients) and no loss of balance due to hallux weakness (76%; thirty-five of forty-six patients

  10. Cadaveric study of zone 2 flexor hallucis longus tendon sheath.

    PubMed

    Lui, Tun Hing; Chan, Kwok Bill; Chan, Lap Ki

    2010-06-01

    The purpose of this study was to investigate the anatomy of the zone 2 flexor hallucis longus (FHL) tendon sheath. Dissection of the zone 2 FHL tendon sheath was performed in 12 feet of 6 cadavers. The tendon sheath was subdivided into proximal fibrous (zone 2A) and distal fascial (zone 2B) parts. The lengths of the zone 2A and 2B FHL tendon were measured and represented the length of the corresponding tendon sheaths, and the relation of the medial plantar nerve to each part of the zone 2 FHL tendon sheath was studied. In all specimens there were fibrous and fascial components of the zone 2 FHL tendon sheath. The medial plantar nerve crossed the zone 2B tendon sheaths and then became plantar lateral to the sheath in 7 specimens. The distance between the medial plantar nerve and the orifice of the zone 2A tendon sheath averaged 7.6 mm. The distance between the medial plantar nerve and the junction between zones 2A and 2B averaged 3.2 mm. The distance between the medial plantar nerve and the distal end of the zone 2B tendon sheath averaged 4.2 mm. The mean length of the zone 2A tendon sheath was 35.9 mm, and the mean length of the zone 2B tendon sheath was 30.5 mm. The zone 2 FHL tendon sheath can be subdivided into a proximal fibrous zone (2A) and a distal fascial zone (2B). Because of the close proximity of the medial plantar nerve to the tendon sheath, there is a significant risk of iatrogenic nerve injury when surgical procedures are performed in zone 2B. An understanding of the anatomy of the zone 2 FHL tendon sheath is useful for the safe practice of zone 2 FHL tendoscopy. Copyright (c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Flexor bias of joint position in humans during spaceflight

    NASA Technical Reports Server (NTRS)

    McCall, G. E.; Goulet, C.; Boorman, G. I.; Roy, R. R.; Edgerton, V. R.

    2003-01-01

    The ability to estimate ankle and elbow joint position was tested before, during, and after a 17-day spaceflight. Subjects estimated targeted joint angles during isovelocity (IsoV) joint movements with agonist muscle groups either active or relaxed. These movements included elbow extension (EE) and elbow flexion (EF), and plantarflexion (PF) and dorsiflexion (DF) of the ankle. Subjects also estimated these joint positions while moving the dynamometer at their chosen (variable) velocity (VarV) during EE and PF. For IsoV tests, no differences were observed between active and passive movements for either the ankle or elbow. Compared with those of pre-flight test days, estimates of targeted elbow joint angles were approximately 5 degrees to 15 degrees more flexed in-flight, and returned toward the pre-flight values during recovery. The spaceflight effects for the ankle were inconsistent and less prevalent than those for the elbow. The VarV PF test condition for the 120 degrees target angle at the ankle exhibited approximately 5 degrees to 7 degrees more DF target angle estimates in-flight compared with those pre- or post-flight. In contrast, during IsoV PF there was a tendency for ankle estimates to be approximately 2 degrees to 3 degrees more PF after 2-3 days exposure to spaceflight. These data indicate that during spaceflight the perception of elbow extension is greater than actuality, and are consistent with the interpretation that microgravity induced a flexor bias in the estimation of the actual elbow joint position. Moreover, these effects in joint proprioception during spaceflight were observed in individual isolated single-joint movements during tasks in which vestibular function in maintaining posture were minimal.

  12. Mechanical properties of the flexor digitorum profundus tendon attachment.

    PubMed

    Felder, Jerrod J; Guseila, Loredana M; Saranathan, Archana; Shary, Timothy J; Lippitt, Steven B; Elias, John J

    2013-12-01

    The current study was performed to determine the strength and rigidity of the intact flexor digitorum profundus (FDP) tendon attachment and compare the rigidity at the attachment site to the rigidity within a more proximal part of the tendon. Eight cadaveric index fingers were tested to failure of the FDP tendon. Lines were drawn on each tendon with India ink stain at the position of the attachment to bone and 5 mm and 10 mm proximally. Each test was recorded using a high resolution video camera. A minimum of six images per test were used for analysis of tissue deformation. The centroid of each line was computationally identified to characterize the deformation of the tendon between the lines. Force vs. deformation curves were generated for the 5 mm region representing the tendon attachment and the 5 mm region adjacent to the attachment. Stiffness measurements were generated for each curve, and normalized by the initial length to determine the rigidity. The failure strength ranged from 263 N to 548 N, with rigidity values ranging from 2201 N/(mm/mm) to 8714 N/(mm/mm) and from 3459 N/(mm/mm) to 6414 N/(mm/mm) for the attachment and the tendon proximal to the attachment, respectively. The rigidity did not vary significantly between the attachment and proximal tendon based on a Wilcoxon signed rank test (p = 0.2). The measured strength and rigidity establish biomechanical properties for the FDP tendon attachment to bone.

  13. Flexor bias of joint position in humans during spaceflight

    NASA Technical Reports Server (NTRS)

    McCall, G. E.; Goulet, C.; Boorman, G. I.; Roy, R. R.; Edgerton, V. R.

    2003-01-01

    The ability to estimate ankle and elbow joint position was tested before, during, and after a 17-day spaceflight. Subjects estimated targeted joint angles during isovelocity (IsoV) joint movements with agonist muscle groups either active or relaxed. These movements included elbow extension (EE) and elbow flexion (EF), and plantarflexion (PF) and dorsiflexion (DF) of the ankle. Subjects also estimated these joint positions while moving the dynamometer at their chosen (variable) velocity (VarV) during EE and PF. For IsoV tests, no differences were observed between active and passive movements for either the ankle or elbow. Compared with those of pre-flight test days, estimates of targeted elbow joint angles were approximately 5 degrees to 15 degrees more flexed in-flight, and returned toward the pre-flight values during recovery. The spaceflight effects for the ankle were inconsistent and less prevalent than those for the elbow. The VarV PF test condition for the 120 degrees target angle at the ankle exhibited approximately 5 degrees to 7 degrees more DF target angle estimates in-flight compared with those pre- or post-flight. In contrast, during IsoV PF there was a tendency for ankle estimates to be approximately 2 degrees to 3 degrees more PF after 2-3 days exposure to spaceflight. These data indicate that during spaceflight the perception of elbow extension is greater than actuality, and are consistent with the interpretation that microgravity induced a flexor bias in the estimation of the actual elbow joint position. Moreover, these effects in joint proprioception during spaceflight were observed in individual isolated single-joint movements during tasks in which vestibular function in maintaining posture were minimal.

  14. Modulation of cutaneous flexor responses induced in man by vibration-elicited proprioceptive or exteroceptive inputs.

    PubMed

    Martin, B J; Roll, J P; Hugon, M

    1990-10-01

    The effects of muscle tendon or skin vibration on the early and late components of polyphasic cutaneous responses elicited in the flexor carpi radialis by electrical stimulation of the radial nerve at the wrist were studied in the human, with all muscles at rest. Both early and late flexor responses were enhanced by flexor vibration and depressed by extensor vibration; facilitation was accompanied by a reduction of latency. Furthermore, when an "antagonist vibration response" was present, inhibition of the flexor reflexes was replaced by a facilitation. Palm skin vibration depressed both components of the flexor reflex, while dorsal or "back-hand" skin vibration induced either a facilitation or an inhibition. In addition, back-hand vibration modified the location of the sensations evoked by electrical stimulation of the nerve. In all cases, vibratory stimulus attenuated the perceived intensity of the electrical stimulus. These observations indicate that proprioceptive or exteroceptive information can modulate the gain of the cutaneous reflex loops in a flexible way, under supraspinal control. These data also suggest a possible impairment of the protective withdrawal reflex under vibratory environmental conditions at rest and eventually in active muscles.

  15. Biomechanical analysis of flexor digitorum profundus and superficialis in grip-strength generation.

    PubMed

    Kaufmann, Robert A; Kozin, Scott H; Mirarchi, Adam; Holland, Burt; Porter, Scott

    2007-09-01

    Grip strength is generated through extrinsic flexor tendon and intrinsic muscle actuation. In the study reported here, we analyzed the grip-generating properties of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons during grip-strength generation. In vivo gripping was reproduced in 11 cadaveric forearms through pneumatic tensioning of flexor tendons. A Jamar dynamometer (TEC, Clifton, NJ) was positioned in the hand at varying degrees of angulation measured between the Jamar compression axis and the second metacarpal. Maximum gripping strength during isolated FDP and FDS tensioning generated maximum compressive forces at different angles (P < .0001). The isolated FDP showed continued increased grip strength with larger angles and was most effective when the dynamometer handle was in contact with the distal phalanx. The isolated FDS was most effective at smaller angles when the handle made contact with the middle phalanx. The isolated FDS shows an initial increase in grip strength as the contact point moves toward the middle phalanx (P < .01) and then a tendency for grip strength to decline as the contact point moves over the distal phalanx (P < .01). The FDP and FDS tendons demonstrate unique abilities to generate compression on a dynamometer. This knowledge is important to consider when evaluating grip strength in patients who have injured the extrinsic finger flexors.

  16. Studies in flexor tendon reconstruction: biomolecular modulation of tendon repair and tissue engineering.

    PubMed

    Chang, James

    2012-03-01

    The Andrew J. Weiland Medal is presented each year by the American Society for Surgery of the Hand and the American Foundation for Surgery of the Hand for a body of work related to hand surgery research. This essay, awarded the Weiland Medal in 2011, focuses on the clinical need for flexor tendon reconstruction and on investigations into flexor tendon biology. Reconstruction of the upper extremity is limited by 2 major problems after injury or degeneration of the flexor tendons. First, adhesions formed after flexor tendon repair can cause decreased postoperative range of motion and hand function. Second, tendon losses can result from trauma and degenerative diseases, necessitating additional tendon graft material. Tendon adhesions are even more prevalent after tendon grafting; therefore these 2 problems are interrelated and lead to considerable disability. The total costs in terms of disability and inability to return to work are enormous. In this essay, published work from the past 12 years in our basic science laboratory is summarized and presented with the common theme of using molecular techniques to understand the cellular process of flexor tendon wound healing and to create substances and materials to improve tendon repair and regeneration. These are efforts to address 2 interrelated and clinically relevant problems that all hand surgeons face in their practice. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Surface modification counteracts adverse effects associated with immobilization after flexor tendon repair.

    PubMed

    Zhao, Chunfeng; Sun, Yu-Long; Jay, Gregory D; Moran, Steven L; An, Kai-Nan; Amadio, Peter C

    2012-12-01

    Although post-rehabilitation is routinely performed following flexor tendon repair, in some clinical scenarios post-rehabilitation must be delayed. We investigated modification of the tendon surface using carbodiimide derivatized hyaluronic acid and lubricin (cd-HA-Lub) to maintain gliding function following flexor tendon repair with postoperative immobilization in a in vivo canine model. Flexor digitorum profundus tendons from the 2nd and 5th digits of one forepaw of six dogs were transected and repaired. One tendon in each paw was treated with cd-HA-Lub; the other repaired tendon was not treated. Following tendon repair, a forearm cast was applied to fully immobilize the operated forelimb for 10 days, after which the animals were euthanized. Digit normalized work of flexion (nWOF) and tendon gliding resistance were assessed. The nWOF of the FDP tendons treated with cd-HA-Lub was significantly lower than the nWOF of the untreated tendons (p < 0.01). The gliding resistance of cd-HA-Lub treated tendons was also significantly lower than that of the untreated tendons (p < 0.05). Surface treatment with cd-HA-Lub following flexor tendon repair provides an opportunity to improve outcomes for patients in whom the post-operative therapy must be delayed after flexor tendon repair. Copyright © 2012 Orthopaedic Research Society.

  18. [Relationship of the flexor hallucis longus and flexor digitorum longus tendons in the plantar midfoot. An anatomical cadaver study].

    PubMed

    Filan, P; Hart, R

    2011-01-01

    To verify, in cadaver specimens, the precise anatomic structure of cross-connection between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons and to identify its position in relation to orientation points in the foot in view of the surgical technique for tendon transfer, including the necessity of subsequent tendon suture. A hundred cadaver legs (50 cadavers of 29 men and 21 women, all Caucasians) were dissected by an extensive medio-plantar approach. The anatomical relationship of the FHL and FDL tendons was studied. The distances measured were as follows: between the first metatarsophalangeal joint line and the FHL origin of a tendinous slip; between the slip and the calcaneal tubercle; and the total distance between the first metatarsophalangeal joint line and the calcaneal tubercle. In all cadaver legs, a cross-connection between the FHL and FDL tendons was present in the plantar midfoot. There was always a tendinous slip branching from the FHL tendon and running lateral and distal to the FDL tendon. The slip was attached to the FDL tendon distal to its branching for the toes; it either attached to only the FDL tendon for the second toe or it split to attach to the FDL tendon branches for the second and the third toe. The two configurations were referred to as type II and type II,III, respectively. Type II was found in both legs of 31 cadavers (62 %), and type II,III in 14 cadavers (28 %). In five cadavers (10 %) attachment was different in the right and the left foot. Expressed in absolute numbers, there were 67 type II attachments (two-thirds of the findings) and 33 type II,III attachments (one-third of the findings). The average distance between the first metatarsophalangeal joint line and the origin of an FHL tendinous slip was 7.3 (± 0.9 ) cm, the average distance between the origin of an FHL tendinous slip and the calcaneal tubercle was 9.2 (± 1.1) cm and the average distance between the first metatarsophalangeal joint line and

  19. Ultrasonographic assessment of longitudinal median nerve and hand flexor tendon dynamics in carpal tunnel syndrome.

    PubMed

    Korstanje, Jan-Wiebe H; Scheltens-De Boer, Marjan; Blok, Joleen H; Amadio, Peter C; Hovius, Steven E R; Stam, Henk J; Selles, Ruud W

    2012-05-01

    Changes in subsynovial connective tissue (SSCT) in carpal tunnel syndrome (CTS) patients may result in altered dynamics; consequently, quantification of these dynamics might support objective diagnosis of CTS. We measured and compared longitudinal excursion of the flexor digitorum superficialis and profundus tendons, the median nerve, and the SSCT between the most and least affected hands of 51 CTS patients during extension-to-fist motion. Median nerve and flexor digitorum superficialis tendon excursions in the most affected hands were smaller than in the least affected hands of the same patients, whereas the excursions of the flexor digitorum profundus were larger. Based on these excursions, logistic regression models classified between 67% and 86% of the hands correctly as having CTS. The altered hand dynamics in CTS patients may have implications for the pathophysiology and clinical evaluation of CTS, and ultrasound-based classification models may further support the diagnosis of CTS. Copyright © 2012 Wiley Periodicals, Inc.

  20. Temporal muscle activation assessment by ultrasound imaging during flexor withdrawal reflex and voluntary contraction.

    PubMed

    Jose, Gomez-Tames; Shuto, Nakamura; Jose, Gonzalez; Wenwei, Yu

    2013-01-01

    Activating flexor reflexes by electrical stimulation has been used as a mechanism to initiate the swing phase or to enhance it for spinal cord injured patients. However, it is necessary to know their contraction dynamics in order to artificially induce them at the right moment of a walking cycle. This requires understanding the temporal activation pattern of both surface and deep muscles simultaneously. This study aimed at developing a system to measure and analyze the temporal activation of both surface and deep muscles during voluntary contraction and flexor reflexes (also called withdrawal reflexes) using ultrasound imaging. A set of experiments were done to verify the validity of the system, while exploring the temporal pattern of muscle activation during flexor reflexes. As a result, we were able to quantify the surface and deep muscle activity by measuring the muscle thickness, pennation angle and long-axis displacement, from the ultrasound images.

  1. Safety and effectiveness of flexor tenotomies to heal toe ulcers in persons with diabetes.

    PubMed

    Kearney, Tyler P; Hunt, Nathan A; Lavery, Lawrence A

    2010-09-01

    To evaluate the effectiveness and safety of percutaneous tenotomy of the flexor digitorum longus to heal neuropathic ulcers on the tip of the toe. We retrospectively reviewed a cohort of 48 patients with 58 tenotomy procedures with diabetes related neuropathy and ulceration at the tip of the toe. Subjects were treated with tenotomy of the flexor digitorum longus. We then evaluated healing of the ulceration and any adverse events including recurrence, infection, healing failure, and amputation. 98.3% of the ulcerations healed. Mean ulcer healing time was 40+/-52 days. 12.1% had a recurrence of ulceration at the same site. Mean time to recurrence was 13.9 months. Five percent had post-operative soft tissue infection. Two patients had amputation of the digit; both had pre-existing osteomyelitis. Mean follow up was 28 months. Flexor tenotomy is a safe, simple procedure, which can enhance patients' healing potential with very little risk. Published by Elsevier Ireland Ltd.

  2. Das DNA-Puzzle

    NASA Astrophysics Data System (ADS)

    Kirchner, Stefan

    Im Jahre 1953 wurde von James Watson und Francis Crick erstmalig der strukturelle Aufbau der sogenannten DNA (Desoxyribonukleinsäure) beschrieben, welche das Erbgut jedes Lebewesens enthält. Der wesentliche Teil des Erbguts wird dabei durch eine sehr lange Folge der vier Basen Adenin (A), Cytosin (C), Guanin (G) und Thymin (T) codiert. Seit einigen Jahren ist es möglich, die Folge der vier Basen zu einer gegebenen DNA zu bestimmen. Biologen bezeichnen diesen Vorgang als Sequenzierung.

  3. Effects of Age on Strength and Morphology of Toe Flexor Muscles.

    PubMed

    Mickle, Karen J; Angin, Salih; Crofts, Gillian; Nester, Christopher J

    2016-12-01

    Study Design Descriptive, cross-sectional. Background Age-related muscle atrophy is common in lower-limb muscles. We therefore speculated that foot muscles may also diminish with age. However, there is a paucity of literature characterizing foot muscle strength and morphology, and any relationship between these 2, in older people. Objective To compare the strength and size of the toe flexor muscles of older adults relative to their younger counterparts. Methods Seventeen young adults with a normal foot type were matched by sex and body mass index to 17 older adults with a normal foot type, from an available sample of 41 younger (18 to 50 years of age) and 44 older (60 or more years of age) adults. Among the matched groups (n = 34), muscle thickness and cross-sectional area for 5 intrinsic and 2 extrinsic toe flexor muscles were obtained using ultrasound. Toe strength was assessed using a pressure platform. Differences in toe flexor strength and muscle size between the young and older matched groups were determined using analysis of covariance (controlling for height). Correlations between strength and size of the toe flexor muscles of the pooled group (n = 34) were also calculated. Results Toe strength and the thickness and cross-sectional area of most foot muscles were significantly reduced in the older adults (P<.05). Hallux and toe flexor strength values were strongly correlated with the size of the intrinsic toe flexor muscles. Conclusion The smaller foot muscles appear to be affected by sarcopenia in older adults. This could contribute to reduced toe flexion force production and may affect the ability of older people to walk safely. Interventions aimed at reversing foot muscle atrophy in older people require further investigation. J Orthop Sports Phys Ther 2016;46(12):1065-1070. Epub 29 Oct 2016. doi:10.2519/jospt.2016.6597.

  4. Reliability of ultrasound to measure morphology of the toe flexor muscles

    PubMed Central

    2013-01-01

    Background Measuring the strength of individual foot muscles is very challenging; however, measuring muscle morphology has been shown to be associated with strength. A reliable method of assessing foot muscle atrophy and hypertrophy would therefore be beneficial to researchers and clinicians. Thus, the aim of this study was to evaluate the test-retest intra-observer reliability of ultrasound to measure the morphology of the primary toe flexor muscles. Method The abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, quadratus plantae and abductor digiti minimi muscles in the foot, and the flexor digitorum longus and flexor hallucis longus muscles in the shank were assessed in five males and five females (mean age = 32.1 ± 10.1 years). Muscles were imaged using a GE Venue 40 ultrasound (6-9 or 7.6-10.7 MHz transducer) in a random order, and on two occasions 1-6 days apart. Muscle thickness and cross-sectional area were measured using Image J software with the assessor blinded to muscle and day of scan. Intraclass correlation coefficients (ICC) and limits of agreement were calculated to assess day-to-day repeatability of the measurements. Results The method was found to have good reliability (ICC = 0.89-0.99) with limits of agreement between 8-28% of the relative muscle size. Conclusion The protocol described in this paper showed that ultrasound is a reliable method to measure morphology of the toe flexor muscles. The portability and advantages of ultrasound make it a useful tool for clinical and research settings. PMID:23557252

  5. The relationship of trigger finger and flexor tendon volar migration after carpal tunnel release.

    PubMed

    Lee, S K; Bae, K W; Choy, W S

    2014-09-01

    It has been suggested that the increased frequency of trigger finger (TF) after carpal tunnel release (CTR) may be caused by the volar migration of the flexor tendons at the wrist altering the tendon biomechanics at the A1 pulley. This hypothesis has not been validated. We performed pre- and post-operative ultrasonography (USG) on the affected wrists of 92 patients who underwent CTR. Pre-operative USG was performed in neutral with no tendon loading; post-operative USG was performed in neutral unloaded and in various positions of wrist flexion whilst loading the flexor tendons with gripping. The mean volar migration of the flexor tendons after CTR was 2.2 (SD 0.4) mm in the unloaded neutral position. It was 1.8 (SD 0.4) mm in patients who did not develop TF and 2.5 (SD 0.5) mm in those who did (p = 0.0067). In loaded wrist flexion, the mean volar migration of flexor tendons after CTR in patients who did not develop TF and those who did was 2.1 and 3.0 mm in 0° flexion; 3.2 and 3.9 mm in 15° flexion; 4.3 and 5.1 mm in 30° flexion; and 4.9 and 5.8 mm in 45° flexion, respectively. There were significant differences between patients with and without TF at each flexion angle. Our data indicate that patients with greater volar migration of the flexor tendons after CTR are more likely to develop TF. This conclusion supports the hypothesis that the occurrence of TF after CTR may be caused by the bowstringing effects of the flexor tendons. © The Author(s) 2013.

  6. Knee extension fatigue attenuates repeated force production of the elbow flexors.

    PubMed

    Halperin, Israel; Aboodarda, Saied J; Behm, David G

    2014-01-01

    Non-local muscle fatigue has been demonstrated with unilateral activities, where fatiguing one limb alters opposite limb forces. Fewer studies have examined if non-local fatigue occurs with unrelated muscles. The purpose of this study was to investigate if knee extensors fatigue alters elbow flexors force and electromyography (EMG) activity. Eighteen males completed a control and fatiguing session (randomised). Blood lactate was initially sampled followed by three maximal voluntary contractions (MVC) with the elbow flexors and two with the knee extensors. Thereafter, subjects either sat (control) or performed five sets of bilateral dynamic knee extensions to exhaustion using a load equal to the dominant limb MVC (1-min rest between sets). Immediately afterwards, subjects were assessed for blood lactate and unilateral knee extensors MVC, and after 1 min performed a single unilateral elbow flexor MVC. Two minutes later, subjects performed 12 unilateral elbow flexor MVCs (5 s contraction/10 s rest) followed by a third blood lactate test. Compared to control, knee extensor force dropped by 35% (p < 0.001; ES = 1.6) and blood lactate increased by 18% (p < 0.001; ES = 2.8). Elbow flexor forces were lower after the fatiguing protocol only during the last five MVCs (p < 0.05; ES = ∼ 0.58; ∼ 5%). No changes occurred between conditions in EMG. Elbow flexor forces significantly decreased after knee extensors fatigue. The effect was revealed during the later stages of the repeated MVCs protocol, demonstrating that non-local fatigue may have a stronger effect on repeated rather than on single attempts of maximal force production.

  7. One-stage treatment of deep infection following repair of Achilles tendon rupture with flexor hallucis longus transfer.

    PubMed

    Lee, Kang; Moon, Jeong Seok; Seo, Jeong Gook; Lee, Woo Chun

    2009-03-01

    We present one-stage treatment of deep infection following repair of Achilles tendon rupture using flexor hallucis longus transfer. Flexor hallucis longus was used not only to connect the defect in Achillles tendon, but also to control the soft tissue infection with its abundant blood supply, simultaneously. The clinical results for the two patients in this report were excellent without major complication.

  8. Flexor digitorum accessorius causing tarsal tunnel syndrome in a paediatric patient: A case report and review of the literature.

    PubMed

    Molloy, A P; Lyons, R; Bergin, D; Kearns, S R

    2015-06-01

    The flexor digitorium accessorius muscle is an unusual anatomical variant found in the posteromedial aspect of the hindfoot and ankle. As previously described, its location predisposes patients to developing tarsal tunnel syndrome. This case illustrates the diagnosis, treatment and resolution of tarsal tunnel syndrome in a paediatric patient, secondary to the presence of flexor digitorium accessorius muscle.

  9. Intratendinous ganglion of the hand: two case reports occurring in the extensor digitorum communis and the flexor digitorum superficialis tendon

    PubMed Central

    Senda, Hiroya; Mizutani, Jun; Okamoto, Hideki

    2017-01-01

    Abstract An intratendinous ganglion of the hand is a rare entity, and only one case report of flexor tendon has been published in the English literature. We herein report two cases of an intratendinous ganglion occurring in the extensor digitorum communis and flexor digitorum superficialis tendon, respectively. PMID:28164147

  10. Zone 2 flexor tendon injuries: Venturing into the no man's land

    PubMed Central

    Kotwal, Prakash P; Ansari, Mohammed Tahir

    2012-01-01

    Flexor tendon injuries are seen commonly yet the management protocols are still widely debated. The advances in suture techniques, better understanding of the tendon morphology and its biomechanics have resulted in better outcomes. There has been a trend toward the active mobilization protocols with development of multistrand core suture techniques. Zone 2 injuries remain an enigma for the hand surgeons even today but the outcome results have definitely improved. Biomolecular modulation of tendon repair and tissue engineering are now the upcoming fields for future research. This review article focuses on the current concepts in the management of flexor tendon injuries in zone 2. PMID:23325961

  11. The Washington Regimen: rehabilitation of the hand following flexor tendon injuries.

    PubMed

    Dovelle, S; Heeter, P K

    1989-12-01

    This article describes the use of the "Washington Regimen" of early controlled motion in the rehabilitation of flexor tendon injuries of the hand. This regimen is derived from a combination of Kleinert's controlled active extension with rubber-hand passive flexion, Duran's controlled passive techniques, and the modification of the Kleinert orthosis that uses a palmar pulley system. Based on results of clinical investigations, this regimen of early controlled motion appears effective in inhibiting peritendinous scarring, joint contractures, and other complications that commonly occur secondary to flexor tendon repairs. A six-week staged regimen of postoperative rehabilitation is presented. Splint design, exercise regimen, and rationale for treatment are reviewed.

  12. Spontaneous Zone III rupture of the flexor tendons of the ulnar three digits in elderly Korean farmers.

    PubMed

    Lee, G J; Kwak, S; Kim, H K; Ha, S H; Lee, H J; Baek, G H

    2015-03-01

    Spontaneous flexor tendon rupture is a rare condition and the aetiology is not clear. We report 12 elderly Korean farmers with spontaneous flexor tendon ruptures. We found the rupture in the dominant hand in ten patients. A rupture in the little finger was found in all 12 patients (seven with both flexor tendons ruptured and five with only the profundus ruptured), in the ring finger in four patients (the profundus ruptured in all and both flexor tendons in two patients), and in the middle finger a partial rupture of the profundus in one patient. The tendons were ruptured close to the hook of the hamate. Repetitive friction between the flexor tendons and the hamate hook may cause the ruptures. The hamate hook was excised and the ruptured profundus tendons were reconstructed with tendon transfers with quite favourable functional recovery at follow-up of 1 to 2 years. The ruptured superficialis tendons were not reconstructed. Level of Evidence IV.

  13. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation.

    PubMed

    Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik; Sankar, Thangasamy

    2014-04-16

    We report a rare case of an 84-year-old woman who presented with delayed, complete rupture of superficial (flexor digitorum superficialis) and deep flexor tendons (flexor digitorum profundus) of the third, fourth and fifth digits of the right hand in zone V of the flexor tendons. The patient, who was otherwise healthy, active and independent, incurred a closed fracture of her right wrist 18 years ago, which was treated conservatively. Current X-rays and operative findings confirmed a malunited Galeazzi fracture-dislocation with volar dislocation of the ulna from the distal radioulnar joint. She underwent surgical treatment to improve her hand function and agonising neuritis symptoms, as she was unable to use her middle, ring and little fingers and had developed severe neuritis of the ulnar nerve. Exploration and repair of the flexor tendons, nerve decompressions and Darrach procedure were performed. On follow-up, the patient showed improvement in hand function with the neuritis completely resolved.

  14. Long-latency reflexes of elbow and shoulder muscles suggest reciprocal excitation of flexors, reciprocal excitation of extensors, and reciprocal inhibition between flexors and extensors.

    PubMed

    Kurtzer, Isaac; Meriggi, Jenna; Parikh, Nidhi; Saad, Kenneth

    2016-04-01

    Postural corrections of the upper limb are required in tasks ranging from handling an umbrella in the changing wind to securing a wriggling baby. One complication in this process is the mechanical interaction between the different segments of the arm where torque applied at one joint induces motion at multiple joints. Previous studies have shown the long-latency reflexes of shoulder muscles (50-100 ms after a limb perturbation) account for these mechanical interactions by integrating information about motion of both the shoulder and elbow. It is less clear whether long-latency reflexes of elbow muscles exhibit a similar capability and what is the relation between the responses of shoulder and elbow muscles. The present study utilized joint-based loads tailored to the subjects' arm dynamics to induce well-controlled displacements of their shoulder and elbow. Our results demonstrate that the long-latency reflexes of shoulder and elbow muscles integrate motion from both joints: the shoulder and elbow flexors respond to extension at both joints, whereas the shoulder and elbow extensors respond to flexion at both joints. This general pattern accounts for the inherent flexion-extension coupling of the two joints arising from the arm's intersegmental dynamics and is consistent with spindle-based reciprocal excitation of shoulder and elbow flexors, reciprocal excitation of shoulder and elbow extensors, and across-joint inhibition between the flexors and extensors.

  15. Long-latency reflexes of elbow and shoulder muscles suggest reciprocal excitation of flexors, reciprocal excitation of extensors, and reciprocal inhibition between flexors and extensors

    PubMed Central

    Meriggi, Jenna; Parikh, Nidhi; Saad, Kenneth

    2016-01-01

    Postural corrections of the upper limb are required in tasks ranging from handling an umbrella in the changing wind to securing a wriggling baby. One complication in this process is the mechanical interaction between the different segments of the arm where torque applied at one joint induces motion at multiple joints. Previous studies have shown the long-latency reflexes of shoulder muscles (50–100 ms after a limb perturbation) account for these mechanical interactions by integrating information about motion of both the shoulder and elbow. It is less clear whether long-latency reflexes of elbow muscles exhibit a similar capability and what is the relation between the responses of shoulder and elbow muscles. The present study utilized joint-based loads tailored to the subjects' arm dynamics to induce well-controlled displacements of their shoulder and elbow. Our results demonstrate that the long-latency reflexes of shoulder and elbow muscles integrate motion from both joints: the shoulder and elbow flexors respond to extension at both joints, whereas the shoulder and elbow extensors respond to flexion at both joints. This general pattern accounts for the inherent flexion-extension coupling of the two joints arising from the arm's intersegmental dynamics and is consistent with spindle-based reciprocal excitation of shoulder and elbow flexors, reciprocal excitation of shoulder and elbow extensors, and across-joint inhibition between the flexors and extensors. PMID:26864766

  16. Das Zwillingsparadoxon: Gedankenexperimente

    NASA Astrophysics Data System (ADS)

    Genz, Henning

    2002-09-01

    Das vermeintliche Zwillingsparadoxon ist ein Gedankenexperiment mit einem Zwillingspaar: Ein Zwilling reist mit hoher Geschwindigkeit von der Erde weg und kehrt nach einiger Zeit zurück, sein Partner bleibt auf der Erde. Dabei altert der Reisende langsamer als der Ruhende - warum nicht umgekehrt? Ein Vergleich von Uhren, die sich mit konstanter Geschwindigkeit bewegen, zeigt: Der Effekt hängt nur von Geschwindigkeiten und nicht von Beschleunigungen ab. Er beruht also allein auf der Speziellen Relativitätstheorie. Tauschen die Zwillinge in regelmäßigen Abständen Lichtsignale aus, können sie ihr asymmetrisches Altern sogar in Zeitschritten mitprotokollieren.

  17. Das Allgemeine Statistische Archiv

    NASA Astrophysics Data System (ADS)

    Rinne, Horst

    Das Allgemeine Statistische Archiv1, nachfolgend kurz Archiv genannt, ist die älteste, ausschließlich der Statistik gewidmete deutschsprachige wissenschaftliche Fachzeitschrift. Sie ist gut zwanzig Jahre älter als die Deutsche Statistische Gesellschaft, zu deren Publikationsorgan sie mit der Gründung der Gesellschaft im Jahre 1911 wurde. Zeitschrift und Gesellschaft blicken auf eine sehr wechselvolle, aber erfolgreiche gemeinsame Geschichte zurück. Die wissenschaftliche Arbeit der Gesellschaft ist im Archiv und seinen Sonderheften für nachfolgende Generationen dokumentiert.

  18. Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting.

    PubMed

    Mon, Daniel; Zakynthinaki, María S; Cordente, Carlos A; Antón, Antonio J Monroy; Rodríguez, Bárbara Rodríguez; Jiménez, David López

    2015-01-01

    The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting.

  19. [The use of vobenzym in the comprehensive treatment of patients with digital flexor tendon injury].

    PubMed

    Strafun, S S; Tovmasian, V V

    2000-01-01

    The results of treatment of 56 patients with tendons of digital flexors were analyzed. In 28 of them in complex of treatment vobenzim was included, and an early active mobilization as well. Considerable antiinflammatory, antioedematous, secondarily analgetic effect of preparation, its application in early period permitted to realize active movements, to reach high functional result of treatment of patients' were noted.

  20. Entrapment of the Flexor Digitorum Profundus in the Callus after a Closed Distal Radial Fracture

    PubMed Central

    Cavadas, Pedro C.; Rubi, Carlo G.

    2016-01-01

    Summary: A 17-year-old boy sustained a closed distal radius fracture; a closed reduction and external fixation was performed. After failed rehabilitation for digital flexion restriction, a surgical exploration was decided, revealing entrapment of flexor digitorum profundus in the bony callus; tendons were freed, obtaining a full range of motion. PMID:27200249

  1. Entrapment of the Flexor Digitorum Profundus in the Callus after a Closed Distal Radial Fracture.

    PubMed

    Thione, Alessandro; Cavadas, Pedro C; Rubi, Carlo G

    2016-04-01

    A 17-year-old boy sustained a closed distal radius fracture; a closed reduction and external fixation was performed. After failed rehabilitation for digital flexion restriction, a surgical exploration was decided, revealing entrapment of flexor digitorum profundus in the bony callus; tendons were freed, obtaining a full range of motion.

  2. Hip abductor, trunk extensor and ankle plantar flexor endurance in females with and without patellofemoral pain.

    PubMed

    Van Cant, Joachim; Pitance, Laurent; Feipel, Véronique

    2017-01-01

    Previous studies have reported strength deficit in hip abduction, extension and external rotation in females with patellofemoral pain (PFP) when compared with healthy control; however, there is conflicting evidence for a decrease in hip muscle endurance. Therefore, it seems important to evaluate hip muscle endurance in females with PFP. Moreover, trunk extensor and ankle plantar flexor endurance have not yet been evaluate in females with PFP. To compare hip abductor, trunk extensor and ankle plantar flexor endurance between females with and without PFP. Twenty females with PFP (mean age, 21.1 years) and 76 healthy females (mean age, 20.5 years) were recruited. Subject performed three endurance clinical tests: (1) The hip abductor isometric endurance test, (2) The Sorensen test and (3) The heel rise test. Group differences were assessed using an independent t tests, or Mann-Whitney U tests for non-normally distributed data. Subjects with PFP exhibited significantly lower hip abductor, trunk extensor and ankle plantar flexor endurance than healthy controls. On average, subjects with PFP had deficits of 16% in hip abduction, 14% in trunk extension and 26% in ankle plantar flexion. Females with PFP exhibited diminished hip abductor, trunk extensor and ankle plantar flexor endurance compared to healthy controls.

  3. Reconstruction of a congenitally absent flexor pollicis longus in an adult

    PubMed Central

    Shamsian, Negin; Exton, Rebecca; Shibu, MM

    2010-01-01

    Congenital absence of the flexor pollicis longus (FPL) is an unusual finding that is frequently associated with thumb hypoplasia. Isolated FPL absence is the rarest of the congenital thumb anomalies. The present article describes a patient with a congenitally absent FPL, and discusses the chosen method of reconstruction. PMID:22131842

  4. Flexor digitorum profundus laceration in association with closed middle phalangeal fracture: case report.

    PubMed

    Sayegh, Eli T; Strauch, Robert J

    2015-05-01

    We report a patient with a flexor digitorum profundus laceration caused by the volarly displaced proximal fragment of a middle phalangeal fracture. Awareness of this association may allow timely recognition and appropriate treatment. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Tendon properties and muscle architecture for knee extensors and plantar flexors in boys and men.

    PubMed

    Kubo, Keitaro; Teshima, Takanori; Ikebukuro, Toshihiro; Hirose, Norikazu; Tsunoda, Naoya

    2014-05-01

    The purpose of this study was to compare the elastic properties and size of tendinous structures and muscle architecture for knee extensors and plantar flexors in boys and men. Twenty-two early pubescent boys (9.6-12.7yrs) and 23 young adult men (19.8-26.2yrs) participated in this study. The maximal strain and thickness of tendinous structures for knee extensors and plantar flexors were measured using ultrasonography. In addition, the fascicle lengths of vastus lateralis and medial gastrocnemius muscles were measured. The maximal strain of tendinous structures for plantar flexors was significantly greater in boys than in men, while there was no difference in the maximal strain for knee extensors between the two groups. The relative thickness (to body mass(1/3)) of Achilles tendon was significantly greater in boys than in men, although there was no difference in that of patellar tendon between the two groups. The relative fascicle length (to limb length) of vastus lateralis muscle was significantly lower in boys than in men, although there was no difference in that of medial gastrocnemius muscle between the two groups. These results suggest that the amount of changes in the elastic properties and sizes of tendinous structures and in the fascicle lengths from early pubescence to maturity is different for different muscle groups (in particular, the knee extensors and the plantar flexors). Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Validity of parameters in static linear testing of flexor tendon repair.

    PubMed

    Linnanmäki, Lasse; Göransson, Harry; Havulinna, Jouni; Sippola, Petteri; Karjalainen, Teemu; Leppänen, Olli V

    2016-09-06

    To study the biomechanical properties of flexor tendon repairs, static tensile testing is commonly used because of its simplicity. However, cyclic testing resembles the physiological loading more closely. The aim of the present study is to assess how the biomechanical competence of repaired flexor tendons under cyclic testing relates to specific parameters derived from static tensile testing. Twenty repaired porcine flexor tendons were subjected to static tensile testing. Additional 35 specimens were tested cyclically with randomly assigned peak load for each specimen. Calculated risks of repair failure during repetitive loading were determined for mean of each statically derived parameter serving as a peak load. Furthermore, we developed a novel objective method to determine the critical load, which is a parameter predicting the survival of the repair in cyclic testing. The mean of statically derived yield load equalled the mean of critical load, justifying its role as a valid surrogate for critical load. However, regarding mean of any determined parameter as a clinically safe threshold is arbitrary due to the natural variation among samples. Until the universal performance of yield load is verified, we recommend employing cyclically derived critical load as primary parameter when comparing different methods of flexor tendon repair. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Considerations in the surgical use of the flexor sheath and pulley system.

    PubMed

    Lowrie, A G; Lees, V C

    2014-01-01

    The use of the digital flexor sheath to reconstruct damaged structures in the fingers is an intriguing but under-investigated subject. The sheath is anchored firmly to the phalanges and palmar plates and has well-vascularized outer and synovial inner layers. The middle layer is strong and fibrous and not all of it is required for its main biomechanical function of maintaining the moment arm of the flexor tendons. These characteristics have led to several descriptions of different reconstructive uses. In sheath reconstruction, flaps can be used to repair damaged A2 and A4 pulleys. As an anchor, the sheath is useful for tenodeses and tendon transfers. It has been used in the correction of ulnar claw and swan neck deformities. In ligament reconstruction, the A1 pulley has been used to reconstruct the transverse intermetacarpal ligament in cleft hand and ray amputations. The sheath has also been used to cover tendon repairs and periosteal defects with the aim of decreasing adhesions. There is potential for further use of the flexor sheath in reconstructive surgery. The digital flexor sheath can be used to restore various finger functions providing its physiological roles are recognized and preserved. This review considers the different techniques described and their potential uses.

  8. Growth factor and protease expression during different phases of healing after rabbit deep flexor tendon repair.

    PubMed

    Berglund, M E; Hart, D A; Reno, C; Wiig, M

    2011-06-01

    The purpose of the study was to contribute to the mapping of molecular events during flexor tendon healing, in particular the growth factors insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF) and nerve growth factor (NGF), matrix metalloproteinases (MMP-3 and MMP-13) and their inhibitors (tissue inhibitors of metalloproteinases, TIMP-1 and TIMP-3, and the protease cathepsin K. In a rabbit model of flexor tendon injury, the mRNA expression for the growth factors, MMPs and TIMPs were measured in tendon and tendon sheath tissue at several time points (3, 6, 21, and 42 days) representing different phases of the healing process. We found that MMP-13 remained increased during the study period, whereas MMP-3 returned to normal levels within the first week after injury. TIMP-3 was down-regulated in the tendon sheaths. Cathepsin K was up-regulated in tendons and sheaths after injury. NGF was present in both tendons and sheaths, but unaltered. IGF-1 exhibited a late increase in the tendons, while VEGF was down-regulated at the later time points. In conclusion, we have demonstrated the presence of NGF in flexor tendons. MMP-13 expression appears to play a more protracted role in flexor tendon healing than MMP-3. The relatively low levels of endogenous IGF-1 and VEGF mRNA following injury support their potential beneficial role as exogenous modulators to optimize tendon healing and strength without increasing adhesion formation.

  9. Sonographic analyses of pulley and flexor tendon in idiopathic trigger finger with interphalangeal joint contracture.

    PubMed

    Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro

    2014-06-01

    This study investigated the sonographic appearance of the pulley and flexor tendon in idiopathic trigger finger in correlation with the contracture of the interphalangeal (IP) joint in the thumb or proximal IP (PIP) joint in the other digits. Sonographic measurements using axial images were performed in 177 affected digits including 17 thumbs and 34 other digits judged to have IP or PIP joint contracture and 77 contralateral control digits. The A1 pulley of the contracture group was significantly thicker than that of the non-contracture group in all digits, whereas the flexor tendon was thicker only in digits other than the thumb. In the analysis using calculated cut-off values, A1 pulley thickening in the thumb and A1 pulley and flexor tendon thickening in the other digits showed statistically significant correlations with IP or PIP joint contracture. This study sonographically confirmed previous reports showing that enlargement of the flexor tendons contribute to the pathogenesis of PIP joint contracture. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  10. Isokinetic assessment of knee flexor/extensor muscular strength in elderly women.

    PubMed

    Aquino, Marcos de Amorim; Leme, Luiz Eugênio Garcez; Amatuzzi, Marco Martins; Greve, Júlia Maria D'Andréa; Terreri, Antônio Sérgio A P; Andrusaitis, Félix Ricardo; Nardelli, Júlio César de Carvalho

    2002-01-01

    To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients. Twenty-six volunteers aged 75 to 83 years were studied using a Cybex 6000 isokinetic dynamometer. The chosen angular velocity was 60 degrees /s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate. There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 +/- 9.09 Nm / ND = 40.65 +/- 9.38 Nm) and extensor (D = 76.92 +/- 13.97 Nm / ND = 77.65 +/- 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides. The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 degrees /s is proper and safe for isokinetic assessment of elderly people.

  11. Amputation of finger by horse bite with complete avulsion of both flexor tendons.

    PubMed

    Koren, Lior; Stahl, Shalom; Rovitsky, Alexey; Peled, Eli

    2011-08-08

    Amputation of fingers with tendon avulsion occurs through a traction injury, and most occur through a ring avulsion mechanism. Usually the flexor digitorum profundus is torn out with the amputated finger. Replantation usually is recommended only when the amputation is distal to the flexor digitorum superficialis insertion. Animal bites are relatively common, with a decreasing order of frequency of dogs, cats, and humans. Horse bites are relatively infrequent but are associated with crush injuries and tissue loss when they occur. This article describes a 23-year-old man with amputation of his middle finger at the level of the proximal phalanx after being bitten by a horse. The amputated stump was avulsed with the middle finger flexor digitorum profundus and flexor digitorum superficialis torn from the muscle-tendon junction from approximately the middle of the forearm. The patient had no other injuries, and he was able to move his other 4 fingers with only mild pain. As the amputated digit was not suitable for replantation, the wound was irrigated and debrided. The edges of the phalanx were trimmed, and the edges of the wound were sutured. Tetanus toxoid and rabies vaccine were administered, along with intravenous amoxicillin and clavulanic acid. The patient was discharged from the hospital 2 days later, with no sign of infection of the wound or compartment syndrome of the forearm. This case demonstrates the weakest point in the myotendinous junction and emphasizes the importance of a careful physical examination in patients with a traumatic amputation. Copyright 2011, SLACK Incorporated.

  12. Reduced biceps femoris myoelectrical activity influences eccentric knee flexor weakness after repeat sprint running.

    PubMed

    Timmins, R G; Opar, D A; Williams, M D; Schache, A G; Dear, N M; Shield, A J

    2014-08-01

    The aim of this study was to determine whether declines in knee flexor strength following overground repeat sprints were related to changes in hamstrings myoelectrical activity. Seventeen recreationally active men completed maximal isokinetic concentric and eccentric knee flexor strength assessments at 180°/s before and after repeat sprint running. Myoelectrical activity of the biceps femoris (BF) and medial hamstrings (MHs) was measured during all isokinetic contractions. Repeated measures mixed model [fixed factors = time (pre- and post-repeat sprint) and leg (dominant and nondominant), random factor = participants] design was fitted with the restricted maximal likelihood method. Repeat sprint running resulted in significant declines in eccentric, and concentric, knee flexor strength (eccentric = 26 ± 4 Nm, 15% P < 0.001; concentric 11 ± 2 Nm, 10% P < 0.001). Eccentric BF myoelectrical activity was significantly reduced (10%; P = 0.035). Concentric BF and all MH myoelectrical activity were not altered. The declines in maximal eccentric torque were associated with the change in eccentric BF myoelectrical activity (P = 0.013). Following repeat sprint running, there were preferential declines in the myoelectrical activity of the BF, which explained declines in eccentric knee flexor strength.

  13. Tendoscopic Excision of an Intratendinous Ganglion in the Flexor Hallucis Longus Tendon: A Case Report.

    PubMed

    Endo, Jun; Yamaguchi, Satoshi; Sasho, Takahisa

    2016-01-01

    Intratendinous ganglion cysts are rare lesions of unknown etiology that originate within a tendon. We report the case of a 34-year-old female with an intratendinous ganglion in the plantar portion of the flexor hallucis longus tendon. The intratendinous ganglion recurred after ultrasound-guided needle aspiration. Tendoscopic excision of the intratendinous ganglion cyst achieved a satisfactorily result without recurrence.

  14. Flexion synergy overshadows flexor spasticity during reaching in chronic moderate to severe hemiparetic stroke.

    PubMed

    Ellis, Michael D; Schut, Ingrid; Dewald, Julius P A

    2017-07-01

    Pharmaceutical intervention targets arm flexor spasticity with an often-unsuccessful goal of improving function. Flexion synergy is a related motor impairment that may be inadvertently neglected. Here, flexor spasticity and flexion synergy are disentangled to determine their contributions to reaching dysfunction. Twenty-six individuals participated. A robotic device systematically modulated shoulder abduction loading during ballistic reaching. Elbow muscle electromyography data were partitioned into windows delineated by elbow joint velocity allowing for the separation of synergy- and spasticity-related activation. Reaching velocity decreased with abduction loading (p<0.001) such that velocity was 30% slower when lifting the arm at 50% of abduction strength compared to when arm weight was supported. Abnormal flexion synergy increased with abduction loading (p<0.001) such that normalized activation ranged from a median (interquartile range) of 0.07 (0.03-0.12) when arm weight was supported to 0.19 (0.12-0.40) when actively lifting (large effect size, d=0.59). Flexor spasticity was detected during reaching (p=0.016) but only when arm weight was supported (intermediate effect size, d=0.33). Flexion synergy is the predominant contributor to reaching dysfunction while flexor spasticity appears only relevant during unnaturally occurring passively supported movement. Interventions targeting flexion synergy should be leveraged in future stroke recovery trials. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  15. Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting

    PubMed Central

    Mon, Daniel; Zakynthinaki, María S.; Cordente, Carlos A.; Antón, Antonio J. Monroy; Rodríguez, Bárbara Rodríguez; Jiménez, David López

    2015-01-01

    The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting. PMID:26121145

  16. EFFECT OF USING WRIST ORTHOSES ON FOREARM FLEXOR AND EXTENSOR MUSCLE ACTIVATION

    PubMed Central

    Novais Van Petten, Adriana Maria Valladão; Ávila, Antônio Ferreira

    2015-01-01

    Objective: To investigate the effect of using wrist immobilization orthoses made from different materials, on activation of the flexor and extensor musculature of the forearm while performing specific tasks. Methods: Twenty-six adults, with an average age of 26.2 years, underwent the Jebsen-Taylor functional hand test and the grip strength test (Jamar® dynamometer) under three conditions: free hand, wearing a composite orthosis and wearing a thermoplastic orthosis. The tests were carried out using the dominant hand only. During the tests, surface electrodes were attached to the flexor and extensor muscles of the forearm to record the muscle electrical activity. The results obtained under the three conditions were compared and analyzed using the Wilcoxon statistical test. Results: Significant differences in muscle activation were found between using the free hand and using any of the orthoses. There was no significant difference in muscle activation between the two types of orthosis. A decrease in activity of the extensor muscles of the forearm was observed during all the tasks, as well as an increase in activation of the flexor muscles with the use of the orthoses. Conclusion: These results are important for defining whether an orthosis should be prescribed during the rehabilitation process for a wide range of disorders, such as tendinitis of the flexors and extensors of the wrist and fingers, as well as for predicting the length of time for which these devices should be used. PMID:27022523

  17. Recovery kinetics of knee flexor and extensor strength after a football match.

    PubMed

    Draganidis, Dimitrios; Chatzinikolaou, Athanasios; Avloniti, Alexandra; Barbero-Álvarez, José C; Mohr, Magni; Malliou, Paraskevi; Gourgoulis, Vassilios; Deli, Chariklia K; Douroudos, Ioannis I; Margonis, Konstantinos; Gioftsidou, Asimenia; Flouris, Andreas D; Fouris, Andreas D; Jamurtas, Athanasios Z; Koutedakis, Yiannis; Fatouros, Ioannis G

    2015-01-01

    We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12 h, 36 h and 60 h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12 h, 36 h and 60 h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60 h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (P<0.05) at 12 h (both limbs) and 36 h (dominant limb only), b) eccentric and concentric peak torque of knee extensors and flexors declined (P<0.05) in both limbs for 36 h at 60°/s and for 60 h at 180°/s with eccentric peak torque of knee flexors demonstrating a greater (P<0.05) reduction than concentric peak torque, c) strength deterioration was greater (P<0.05) at 180°/s and in dominant limb, d) the functional ratio was more sensitive to match-induced fatigue demonstrating a more prolonged decline. Discriminant and regression analysis revealed that strength deterioration and recovery may be related to the amount of eccentric actions performed during the match and athletes' football-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players

  18. Eccentric Knee Flexor Strength and Risk of Hamstring Injuries in Rugby Union: A Prospective Study.

    PubMed

    Bourne, Matthew N; Opar, David A; Williams, Morgan D; Shield, Anthony J

    2015-11-01

    Hamstring strain injuries (HSIs) represent the most common cause of lost playing time in rugby union. Eccentric knee flexor weakness and between-limb imbalance in eccentric knee flexor strength are associated with a heightened risk of HSIs in other sports; however, these variables have not been explored in rugby union. To determine if lower levels of eccentric knee flexor strength or greater between-limb imbalance in this parameter during the Nordic hamstring exercise are risk factors for HSIs in rugby union. Cohort study; Level of evidence, 2. This prospective study was conducted over the 2014 Super Rugby and Queensland Rugby Union seasons. In total, 178 rugby union players (mean age, 22.6 ± 3.8 years; mean height, 185.0 ± 6.8 cm; mean weight, 96.5 ± 13.1 kg) had their eccentric knee flexor strength assessed using a custom-made device during the preseason. Reports of previous hamstring, quadriceps, groin, calf, and anterior cruciate ligament injuries were also obtained. The main outcome measure was the prospective occurrence of HSIs. Twenty players suffered at least 1 HSI during the study period. Players with a history of HSIs had a 4.1-fold (95% CI, 1.9-8.9; P = .001) greater risk of subsequent HSIs than players without such a history. Between-limb imbalance in eccentric knee flexor strength of ≥15% and ≥20% increased the risk of HSIs by 2.4-fold (95% CI, 1.1-5.5; P = .033) and 3.4-fold (95% CI, 1.5-7.6; P = .003), respectively. Lower eccentric knee flexor strength and other prior injuries were not associated with an increased risk of future HSIs. Multivariate logistic regression revealed that the risk of reinjuries was augmented in players with strength imbalances. Previous HSIs and between-limb imbalance in eccentric knee flexor strength were associated with an increased risk of future HSIs in rugby union. These results support the rationale for reducing imbalance, particularly in players who have suffered a prior HSI, to mitigate the risk of future

  19. Recovery Kinetics of Knee Flexor and Extensor Strength after a Football Match

    PubMed Central

    Draganidis, Dimitrios; Chatzinikolaou, Athanasios; Avloniti, Alexandra; Barbero-Álvarez, José C.; Mohr, Magni; Malliou, Paraskevi; Gourgoulis, Vassilios; Deli, Chariklia K.; Douroudos, Ioannis I.; Margonis, Konstantinos; Gioftsidou, Asimenia; Fouris, Andreas D.; Jamurtas, Athanasios Z.; Koutedakis, Yiannis; Fatouros, Ioannis G.

    2015-01-01

    We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12h, 36h and 60h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12h, 36h and 60h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (P<0.05) at 12h (both limbs) and 36h (dominant limb only), b) eccentric and concentric peak torque of knee extensors and flexors declined (P<0.05) in both limbs for 36h at 60°/s and for 60h at 180°/s with eccentric peak torque of knee flexors demonstrating a greater (P<0.05) reduction than concentric peak torque, c) strength deterioration was greater (P<0.05) at 180°/s and in dominant limb, d) the functional ratio was more sensitive to match-induced fatigue demonstrating a more prolonged decline. Discriminant and regression analysis revealed that strength deterioration and recovery may be related to the amount of eccentric actions performed during the match and athletes' football-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players' physical

  20. Neck flexor muscle strength and its relation with functional performance in Duchenne muscular dystrophy.

    PubMed

    Bozgeyik, Sibel; Alemdaroğlu, İpek; Bulut, Numan; Yılmaz, Öznur; Karaduman, Ayşe

    2017-05-01

    The aim of this study was to investigate the relationship between neck flexor muscle strength and functional performance in children with DMD. A total of 70 children with DMD between Level 1 and 3 according to Brooke Lower Extremity Functional Classification (BLEFC) were included in the study. Children were divided into 2 groups according to neck flexor strength measured by Medical Research Council Scale as Group 1 (3⁻ and below) and Group 2 (3 and above). Functional performance was assessed by 6 Minute Walk Distance (6MWD) and timed performance tests, and ambulatory status by North Star Ambulatory Assessment (NSAA). Correlations between neck flexor strength and performance tests were analyzed by using Spearman's correlation coefficient in non-parametric conditions. Thirty-six and 34 children were included in Group 1 and 2, respectively. No statistically significant difference was found in BLEFC between groups (z = -1.225, p > 0.05). 6MWD (z = -2.574, p = 0.01) was found to be longer and NSAA (z = -2.565, p = 0.01) was higher in Group 2. Positive, moderate, statistically significant correlations were determined between neck flexor muscle strength and 6MWD (p < 0.01, r = 0.374); NSAA (p < 0.01, r = 0.399) while a negative, weak correlation between neck flexor muscle strength and the duration for standing from supine position (p = 0.02, r = -0.290). The results indicate the relationship of neck flexor muscle strength and functional performance in DMD children. It is thought that the approaches to maintain neck flexor muscle strength from the early stages of disease process may support functional activities of daily life with less compensation and effort in DMD. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  1. Intracellular autogenetic and synergistic effects of muscular contraction on flexor motoneurones

    PubMed Central

    Green, D. G.; Kellerth, J.-O.

    1967-01-01

    1. Intracellular records have been taken from cat motoneurones innervating flexor muscles of the hind limb. Contractions of the ankle flexors tibialis anterior and extensor digitorum longus were elicited by stimulation of the peripheral end of the cut L 7 ventral root and the reflex effects of these contractions were recorded in silent and repetitively firing motoneurones. 2. Contraction usually produces a hyperpolarizing response inside flexor motoneurones. This hyperpolarization is tension-sensitive in the sense that when, at constant muscle extension, the strength of the contraction is increased, the magnitude of the inhibitory response is augmented. 3. Increasing the resting length of the muscles, while using a stimulus of constant strength to the ventral root, causes this inhibitory response to increase in some cells. More often, however, the hyperpolarization caused by contraction is gradually reduced in duration and/or amplitude as the muscles are extended. 4. Even with the muscles slackened, so that they develop no tension at their ends, contraction usually produces prominent hyperpolarization of the motoneurones. 5. By passing polarizing currents or injecting chloride ions through the intracellular micro-electrode, the hyperpolarizing potentials produced by contraction of the slack and extended muscles are shown to be, at least in part, genuinely post-synaptic inhibitory events. 6. When the neurone is fired repetitively by injected current, the `silent period' in contraction corresponds to the hyperpolarization of the post-synaptic membrane. 7. Monosynaptic testing of the flexor motoneurone pool has been used to confirm the essential features of the intracellularly recorded activity. 8. Acutely spinalizing the animal increases the magnitude of the inhibitory responses caused by contraction. 9. Recordings from dorsal root fibres show that Golgi tendon organs of the ankle flexors are very sensitive to contraction and are indeed often activated by the

  2. Effects of the optimal flexor/extensor ratio on G-tolerance

    PubMed Central

    Park, Jung Sub; Choi, Jean; Kim, Jung Woon; Jeon, Sang Yun; Kang, Sunghwun

    2016-01-01

    [Purpose] The aim of this study was to examine the flexor/extensor ratio of the knee joints and compare it with the results of Korean Air Force students in G-tolerance test. [Subjects and Methods] The body composition of Korea Air Force students (n=77) was measured by an impedance method. A muscular function test was performed using a Humac Norm (USA) at angular speeds of 60°/sec and 240°/sec and an isokinetic muscular function test was also conducted. [Results] In the failed C and passing groups, muscle mass and fat percentages were significantly higher than those of students in the failed A group. The BMI of the failed C and passing groups were significantly higher than that of the failed A group. The group that passed had a significantly higher value of left knee 60°/sec flexion peak torque than the failed B group. Moreover, the total work of left knee extension of the failed C group and the passing group was significantly higher than that of the failed A group. The C group and the passing group had significantly higher values of the trunk 60°/sec flexor/extensor ratio than the failed A group, and the total work flexor/extensor ratio of the passing group was significantly higher than that of the failed A group. [Conclusions] Based on these results, balance the right and left knee flexor/extensor ratio, and a high flexor/extensor ratio of the trunk are required to endure a high G-tolerance test (+6G/30 sec). Moreover, an improvement in the maximum muscular strength is necessary to endure a situation of rapidly increasing acceleration in the early stage. PMID:27799715

  3. Tonic Stretch Reflex Threshold as a Measure of Ankle Plantar-Flexor Spasticity After Stroke.

    PubMed

    Blanchette, Andreanne K; Mullick, Aditi A; Moïn-Darbari, Karina; Levin, Mindy F

    2016-05-01

    Commonly used spasticity scales assess the resistance felt by the evaluator during passive stretching. These scales, however, have questionable validity and reliability. The tonic stretch reflex threshold (TSRT), or the angle at which motoneuronal recruitment begins in the resting state, is a promising alternative for spasticity measurement. Previous studies showed that spasticity and voluntary motor deficits after stroke may be characterized by a limitation in the ability of the central nervous system to regulate the range of the TSRT. The study objective was to assess interevaluator reliability for TSRT plantar-flexor spasticity measurement. This was an interevaluator reliability study. In 28 people after stroke, plantar-flexor spasticity was evaluated twice on the same day. Plantar-flexor muscles were stretched 20 times at different velocities assigned by a portable device. Plantar-flexor electromyographic signals and ankle angles were used to determine dynamic velocity-dependent thresholds. The TSRT was computed by extrapolating a regression line through dynamic velocity-dependent thresholds to the angular axis. Mean TSRTs in evaluations 1 and 2 were 66.0 degrees (SD=13.1°) and 65.8 degrees (SD=14.1°), respectively, with no significant difference between them. The intraclass correlation coefficient (2,1) was .851 (95% confidence interval=.703, .928). The notion of dynamic stretch reflex threshold does not exclude the possibility that spasticity is dependent on acceleration, as well as on velocity; future work will study both possibilities. Tonic stretch reflex threshold interevaluator reliability for evaluating stroke-related plantar-flexor spasticity was very good. The TSRT is a reliable measure of spasticity. More information may be gained by combining the TSRT measurement with a measure of velocity-dependent resistance. © 2016 American Physical Therapy Association.

  4. Effect of muscle length on voluntary activation of the plantar flexors in boys and men.

    PubMed

    Kluka, Virginie; Martin, Vincent; Vicencio, Sebastian Garcia; Giustiniani, Mathias; Morel, Claire; Morio, Cédric; Coudeyre, Emmanuel; Ratel, Sébastien

    2016-05-01

    The aim of the present study was to compare the effect of muscle length on the maximal voluntary activation level (VA) of the plantar-flexors between children and adults. Fourteen boys (10.0 ± 1.0 years) and fifteen men (24.6 ± 4.2 years) performed 5-s maximal isometric voluntary contractions (MVC) of the plantar-flexor muscles at seven ankle angles [from 10° in dorsi-flexion (DF) to 20° in plantar-flexion (PF); 0° = reference position; the angle between the plantar surface and leg is a right angle]. Single magnetic stimulations were delivered to the posterior tibial nerve during MVCs to determine VA. Results showed a higher absolute torque of the plantar-flexor muscles at long (10° DF) than at short muscle length (20° PF) in men (89.4 ± 19.4 vs. 46.8 ± 17.0 N m, P < 0.001) and boys (44.9 ± 18.5 vs. 26.6 ± 12.8 N m, P < 0.001). On average, VA was significantly higher in men than in boys (92.4 ± 1.7 vs. 87.6 ± 1.6 %, P < 0.05). However, no significant main effect of the ankle angle was observed on VA. The VA partly accounts for the plantar-flexors MVC torque difference between children and adults but is not affected by the muscle length changes in both groups. Therefore, VA cannot account for the shape of the torque-angle relationship on the plantar-flexor muscles.

  5. Chitosan prevents adhesion during rabbit flexor tendon repair via the sirtuin 1 signaling pathway.

    PubMed

    Chen, Qiang; Lu, Hui; Yang, Hu

    2015-09-01

    Chitosan has been demonstrated to exert potent anti-adhesive activity during tendon repair; however, the underlying molecular mechanisms remain unclear. The present study aimed to investigate the preventive effects of chitosan on adhesion in rabbit tendon repair, and to investigate the role of the sirtuin (SIRT)1 signaling pathway in this process. A total of 30 rabbits were divided randomly into three equal groups: Group 1, saline treatment; group 2, chitosan treatment; and group 3, chitosan + nicotinamide treatment. The flexor tendon of each of the rabbits was injured, and subsequently each rabbit was injected with the one of the reagents. Six weeks post‑surgery, all of the rabbits were sacrificed and their flexor tendons were harvested for subsequent evaluation of adhesion. Western blotting was used to determine the protein expression levels of specific signaling molecules. An MTT assay was conducted to evaluate the viability of human tenocytes and flow cytometry was used to analyze the apoptotic rate of the cells. The present study demonstrated that treatment with chitosan relieved adhesion in the rabbits with flexor tendon injuries. In addition, chitosan treatment increased SIRT1 expression, and reduced acetylated p65 and p53 expression in the tendons. The effects of chitosan on the tendons were attenuated by treatment with nicotinamide (a SIRT1 inhibitor). In the human tenocytes, pretreatment with chitosan resulted in an inhibition of interleukin (IL)‑1β‑induced apoptosis. Furthermore, chitosan reversed the IL‑1β‑induced downregulation of SIRT1 and upregulation of acetylated p65 and p53. Furthermore, downregulation of Sirt1 by RNA interference abrogated the effects of chitosan on the levels of p65 and p53 acetylation, and the rate of tenocyte apoptosis. In conclusion, chitosan treatment prevented adhesion via the SIRT1 signaling pathway during rabbit flexor tendon repair. These results indicate that SIRT1 may be targeted for therapeutic

  6. Turkey model for flexor tendon research: in vitro comparison of human, canine, turkey, and chicken tendons.

    PubMed

    Kadar, Assaf; Thoreson, Andrew R; Reisdorf, Ramona L; Amadio, Peter C; Moran, Steven L; Zhao, Chunfeng

    2017-08-01

    Flexor tendon injuries are one of the most common hand injuries and remain clinically challenging for functional restoration. Canine and chicken have been the most commonly used animal models for flexor tendon-related research but possess several disadvantages. The purpose of this study was to explore a potential turkey model for flexor tendon research. The third digit from human cadaveric hands, canine forepaws, turkey foot, and chicken foot were used for this study. Six digits in each of four species were studied in detail, comparing anatomy of the flexor apparatus, joint range of motioņ tendon excursion, tendon cross-sectional area, work of flexion, gliding resistance at the level of the A2 pulley, modulus of elasticity, suture retention strength, and histology across species. Anatomically, the third digit in the four species displayed structural similarities; however, the tendon cross-sectional area of the turkey and human were similar and larger than canine and chicken. Furthermore, the turkey digit resembles the human's finger with the lack of webbing between digits, similar vascularization, tendon excursion, work of flexion, gliding resistance, mechanical properties, and suture holding strength. More importantly, human and turkey tendons were most similar in histological appearance. Turkey flexor tendons have many properties that are comparable to human flexor tendons which would provide a clinically relevant, economical, nonhuman companion large animal model for flexor tendon research. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Persistent spontaneous synovial drainage from digital flexor sheath in proliferative tenosynovitis: Two case reports and a review of the literature.

    PubMed

    Chin, Brian; Cheung, Kevin; Farhangkhoee, Hana; Thoma, Achilleas

    2015-01-01

    Proliferative flexor tenosynovitis of the hand is an inflammatory process involving the synovial sheaths surrounding the tendons. It is most commonly caused by infection, but may also be caused by overuse, diabetes and rheumatic conditions such as rheumatoid arthritis and crystal arthropathies. The present report describes two patients with severe proliferative tenosynovitis, who developed a fistula between the tendon sheath and skin after instrumentation, resulting in persistent synovial drainage. After failing conservative management, both patients were managed with extensive flexor tenosynovectomy to prevent inoculation of bacteria into the flexor sheath. The presentation, management and outcome of each case is described in addition to a discussion of the literature on tenosynovial fistulas.

  8. TGF-beta1 Suppresses Plasmin and MMP Activity in Flexor Tendon Cells via PAI-1: Implications for Scarless Flexor Tendon Repair

    PubMed Central

    Farhat, Youssef M.; Al-Maliki, Alaa A.; Easa, Anas; O’Keefe, Regis J.; Schwarz, Edward M.; Awad, Hani A.

    2014-01-01

    Flexor tendon injuries caused by deep lacerations to the hands are a challenging problem as they often result in debilitating adhesions that prevent the movement of the afflicted fingers. Evidence exists that tendon adhesions as well as scarring throughout the body are largely precipitated by the pleiotropic growth factor, TGF-β1, but the effects of TGF-β1 are poorly understood in tendon healing. Using an in vitro model of tendon healing, we previously found that TGF-β1 causes gene expression changes in tenocytes that are consistent with scar tissue and adhesion formation, including upregulation of the anti-fibrinolytic protein, PAI-1. Therefore, we hypothesized that TGF-β1 contributes to scarring and adhesions by reducing the activity of proteases responsible for ECM degradation and remodeling, such as plasmin and MMPs, via upregulation of PAI-1. To test our hypothesis, we examined the effects of TGF-β1 on the protease activity of tendon cells. We found that flexor tendon tenocytes treated with TGF-β1 had significantly reduced levels of active MMP-2 and plasmin. Interestingly, the effects of TGF-β1 on protease activity were completely abolished in tendon cells from homozygous PAI-1 KO mice, which are unable to express PAI-1. Our findings support the hypothesis that TGF-β1 induces PAI-1, which suppresses plasmin and plasmin-mediated MMP activity, and provide evidence that PAI-1 may be a novel therapeutic target for preventing adhesions and promoting a scarless, regenerative repair of flexor tendon injuries. PMID:24962629

  9. On the long-latency reflex responses of the human flexor digitorum profundus.

    PubMed Central

    Matthews, P B; Miles, T S

    1988-01-01

    1. Electromyography (surface and intramuscular) has been used to study the reflex responses of the human flexor digitorum profundus (FDP) to angular rotation of the distal interphalangeal joint of the 4th finger. This has been done with the hand in three separate positions which, owing to the arrangement of the various tendons, allow the movement to be transmitted to (a) both the flexor and extensor muscles, (b) FDP alone (extensors disengaged) and (c) neither flexor nor extensor muscles (all muscles disengaged, but cutaneous and joint receptors still potentially activated). The stimuli were applied while the subject was voluntarily contracting FDP to produce a constant level of EMG activity; this remained possible when the muscle was disengaged from the joint. 2. With all muscles connected, FDP behaved similarly to the analogous long flexor of the thumb. 'Stretch' elicited a prolonged complex response starting with a short-latency component corresponding to the tendon jerk. Unloading of the contracting muscle caused a pronounced reduction of its on-going EMG activity. The latency of this latter effect was approximately 20 ms greater than that of the initial stretch-evoked response, thereby demonstrating that it was not due to a disfacilitation via the short-latency pathway (on reduction of the tonic spindle afferent firing from FDP as it shortened). 3. With all muscles disengaged, movement of the joint in either direction evoked simply a weak, variable excitatory response, with a latency somewhat greater than that of the normal unloading response. This was attributed to the activation of cutaneous and/or joint receptors. The effectiveness of the disengagement of the flexor was demonstrated by the abolition of its normal stretch-evoked short-latency response. 4. With the flexor engaged and the extensors disengaged both stretch and release evoked their normal types of response. In control experiments, surface EMG recordings from the interosseus muscles confirmed

  10. Ultrasonographic assessment of flexor tendon mobilization: effect of different protocols on tendon excursion.

    PubMed

    Korstanje, Jan-Wiebe H; Soeters, Johannes N M; Schreuders, Ton A R; Amadio, Peter C; Hovius, Steven E R; Stam, Henk J; Selles, Ruud W

    2012-03-07

    Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon repair to provide tendon excursion sufficient to prevent adhesions. Several cadaver studies have shown that the position of the neighboring fingers influences tendon excursions of the injured finger. We hypothesized that the positions of adjacent fingers influence the long finger flexor digitorum profundus tendon excursion, measured both absolutely and relative to the surrounding tissue of the tendon. Long finger flexor digitorum profundus tendon excursions and surrounding tissue movement were measured in zone V in eleven healthy subjects during three different rehabilitation protocols and two experimental models: (1) an active four-finger mobilization protocol, (2) a passive four-finger mobilization protocol, (3) a modified Kleinert mobilization protocol, (4) an experimental modified Kleinert flexion mobilization model, and (5) an experimental modified Kleinert extension mobilization model. Tendon excursions were measured with use of a frame-to-frame analysis of high-resolution ultrasound images. The median absolute long finger flexor digitorum profundus tendon excursions were 23.4, 17.8, 10.0, 13.9, and 7.6 mm for the active four-finger mobilization protocol, the passive four-finger mobilization protocol, the modified Kleinert mobilization protocol, the experimental modified Kleinert flexion mobilization model, and the experimental modified Kleinert extension mobilization model, respectively, and these differences were all significant (p ≤ 0.041). The corresponding relative flexor digitorum profundus tendon excursions were 11.2, 8.5, 7.2, 10.4, and 5.6 mm. Active four-finger mobilization protocol excursions were significantly (p = 0.013) greater than passive four-finger mobilization protocol excursions but were not significantly greater than experimental modified Kleinert flexion mobilization model excursions (p =0.213). The present study demonstrated large and

  11. Connecting the Dots in DAS

    ERIC Educational Resources Information Center

    Ford, Tracy

    2012-01-01

    Many institutions implement a distributed antenna system (DAS) as part of a holistic approach to providing better wireless coverage and capacity on campus. A DAS provides wireless service within a particular area or structure via a network of separate antenna nodes that are connected to a common source through fiber or coaxial cable. Because DAS…

  12. Connecting the Dots in DAS

    ERIC Educational Resources Information Center

    Ford, Tracy

    2012-01-01

    Many institutions implement a distributed antenna system (DAS) as part of a holistic approach to providing better wireless coverage and capacity on campus. A DAS provides wireless service within a particular area or structure via a network of separate antenna nodes that are connected to a common source through fiber or coaxial cable. Because DAS…

  13. [A method for reconstruction of the A1 retinaculum in the flexor pollicis longus sheath with extensor pollicis brevis tendon].

    PubMed

    Chmiel, Z

    1996-01-01

    An original method for A1 retinaculum reconstruction of flexor pollicis longus sheath with extensor pollicis brevis tendon is presented. Reconstructed retinaculum is very strong. Loss of extensor pollicis brevis did not impaired thumb function.

  14. Comparison of three different peripheral suturing techniques for partial flexor tendon lacerations: a controlled in-vitro biomechanical study.

    PubMed

    Gulihar, A; Hajipour, L; Dias, J J

    2012-01-01

    Surgical repair is advocated for partial flexor tendon lacerations deeper than 70%. We compared gliding resistance with three different peripheral repairs in partial flexor tendon lacerations. Thirty flexor tendons and A2 pulleys were harvested from turkey toes. Gliding resistance was measured for all intact tendons. The tendons were then lacerated to 50% and repaired with a modified Kessler core suture and either a Silfverskiold or Halsted repair or a simple running suture and gliding resistance was measured. Compared to the intact tendon, the increase in gliding resistance after surgical repair was 100% with the Halsted repair, 80% with the Silfverskiold repair and 60% with a running suture (p = 0.05). In conclusion, a simple running suture caused less resistance to gliding compared to the other techniques when repairing partial flexor tendon lacerations and we recommend its use when surgical repair is needed.

  15. Contribution of hind limb flexor muscle afferents to the timing of phase transitions in the cat step cycle.

    PubMed

    Hiebert, G W; Whelan, P J; Prochazka, A; Pearson, K G

    1996-03-01

    1. In this investigation, we tested the hypothesis that muscle spindle afferents signaling the length of hind-leg flexor muscles are involved in terminating extensor activity and initiating flexion during walking. The hip flexor muscle iliopsoas (IP) and the ankle flexors tibialis anterior (TA) and extensor digitorum longus (EDL) were stretched or vibrated at various phases of the step cycle in spontaneously walking decerebrate cats. Changes in electromyogram amplitude, duration, and timing were then examined. The effects of electrically stimulating group I and II afferents in the nerves to TA and EDL also were examined. 2. Stretch of the individual flexor muscles (IP, TA, or EDL) during the stance phase reduced the duration of extensor activity and promoted the onset of flexor burst activity. The contralateral step cycle also was affected by the stretch, the duration of flexor activity being shortened and extensor activity occurring earlier. Therefore, stretch of the flexor muscles during the stance phase reset the locomotor rhythm to flexion ipsilaterally and extension contralaterally. 3. Results of electrically stimulating the afferents from the TA and EDL muscles suggested that different groups of afferents were responsible for the resetting of the step cycle. Stimulation of the TA nerve reset the locomotor step cycle when the stimulus intensity was in the group II range (2-5 xT). By contrast, stimulation of the EDL nerve generated strong resetting of the step cycle in the range of 1.2-1.4 xT, where primarily the group Ia afferents from the muscle spindles would be activated. 4. Vibration of IP or EDL during stance reduced the duration of the extensor activity by similar amounts to that produced by muscle stretch or by electrical stimulation of EDL at group Ia strengths. This suggests that the group Ia afferents from IP and EDL are capable of resetting the locomotor pattern generator. Vibration of TA did not affect the locomotor rhythm. 5. Stretch of IP or

  16. Are Ultrasonographic Measures of Cervical Flexor Muscles Correlated With Flexion Endurance in Chronic Neck Pain and Asymptomatic Participants?

    PubMed

    Ghamkhar, Leila; Kahlaee, Amir Hossein

    2017-06-21

    This study compared the relationship between some clinical factors and the size of neck flexors in participants with or without chronic neck pain. In this case-control study, the correlation between flexor endurance capacity as well as thickness, cross-section area, and shape ratio of longus colli/capitis and sternocleidomastoid muscles were examined in 30 patients with chronic neck pain and 30 asymptomatic participants. The patients showed lower flexor endurance (P = 0.02), smaller thickness (P = 0.03), and cross-section area (P < 0.01) of longus colli as compared with controls. Longus capitis and sternocleidomastoid size were not different between the two groups. The flexor endurance showed a negative correlation with longus colli shape ratio (r = -0.38, P = 0.03) and a positive correlation with longus capitis cross-section area (r = 0.38, P = 0.03) in the patients with chronic neck pain. In the control group, flexor endurance was negatively correlated with longus colli shape ratio (r = -0.45, P = 0.01) but positively correlated with longus capitis thickness (r = 0.45, P = 0.01) and cross-section area (r = 0.38, P = 0.03). Neck disability and pain intensity indices were not significantly correlated with either flexor muscles endurance or size. The ultrasonographic measures of the deep neck flexor muscles and the flexor endurance test, being associated with each other, could successfully differentiate patients with chronic neck pain from asymptomatic participants. However, the endurance test scores were not correlated with self-reported disability or pain intensity indices.

  17. Functional outcome of flexor tendon repair of the hand at Zone 5 and post operative early mobilization of the fingers

    PubMed Central

    Mehdi Nasab, Seyed Abdolhossein; Sarrafan, Nasser; Saeidian, Seyed Reza; Emami, Hassan

    2013-01-01

    Objective : There are few reports on outcome following flexor tendon repair of the hand in zone 5. We hypothesized that early mobilization of the fingers is possible if the suture site of repaired tendon is strong enough. The aim of this study was to assess the results of flexor tendon repair in this zone using modified Kessler method reinforced by peripheral running suture and a post operative early active and passive mobilization of the fingers. Methodology: This prospective study was carried out between April 2006 and Feb 2010, and 171 digits flexor tendons cut in 42 patients were repaired by modified Kessler technique reinforced by running peripheral suture. Early active mobilization and gentle passive motion of the fingers was allowed in a dorsal wrist splint the day after surgery. Wrist Immobilization was performed for one month. Function of the tendons was assessed by Buck-Gramcko score at nine month follow up. Results: Mean age of the patients was 25.4 years (range 17-46 y). Twenty nine flexor policis longus, 77 flexor digitorum superficialis and 65 flexor digitorum profundus tendons of digits were repaired. Middle and index fingers were most commonly involved. Median and ulnar nerve repair was done in 17 and 12 cases respectively. Good to excellent results were seen in of 79.34% of FPL and 74.65% of other finger flexors. One case of FPL rupture was seen. Tenolysis of FDS was performed in one case. Recovery in thenar muscle function was good, fair and poor in 5, 2 and 10 cases after median nerve repair, while all 12 patients with ulnar nerve lesion showed some degrees of clawing of 4th and 5th fingers. Conclusion : Most patients following flexor tendon repair at zone 5 obtained good results. Early motion of the fingers seems to improve outcome in these patients. Concomitant nerve cut in particular of ulnar nerve were associated with a high rate of poor results. PMID:24353505

  18. Flexor digitorum profundus common to thumb and index finger, associated with a post-traumatic distal adherence of both tendons.

    PubMed

    Rico Aguado, A; del Pino Paredes, V

    1988-02-01

    The existence of connections, in the form of tendon slips, between the tendons of the flexor pollicis longus and the flexor digitorum profundus indicis has been described by different authors as being a relatively frequent anomaly. Complete fusion between the two muscles, however, must be considered a very rare anomaly. A bilateral case is described, in which the right hand also had post-traumatic adhesions between the two tendons.

  19. Deep digital flexor tenotomy for treatment of severe laminitis in a cow.

    PubMed

    Gayle, J M; Burrell, G A; Anderson, K L; Redding, W R; Blikslager, A T

    2001-09-01

    A first-calf Guernsey cow was referred for evaluation of severe udder edema, mastitis, metritis, and ketosis. During the course of treatment, the cow became recumbent and was unable to rise. Intensive treatment resulted in the cow being able to stand for short periods with the aid of a sling. However, severe pressure necrosis of the udder and ongoing mastitis made performance of a complete mastectomy necessary. After surgery, the cow's condition improved, although assistance in standing was still required. Radiography of the distal phalanges revealed severe rotation in the right lateral and left medial digits of the hind limbs. The laminitis was nonresponsive to medical management; therefore, a deep digital flexor tenotomy was performed in the affected claws. The procedure provided almost immediate relief of signs of foot pain and resulted in ability to stand without assistance. Deep digital flexor tenotomy should be considered when treating cows with severe laminitis.

  20. Absence of the fourth tendon of the flexor digitorum brevis muscle: a cadaveric study.

    PubMed

    Bernhard, Andrew; Miller, Josh; Keeler, Jason; Siesel, Kathy; Bridges, Evan

    2013-08-01

    This study was undertaken to help confirm the percentages concerning the presence or absence of the flexor digitorum brevis muscle tendon to the fifth toe. We also hope to be able to determine the presence based on gender and nationality. It is known to be absent occasionally; however, there is no definitive study dedicated to its prevalence. Using a pool of 60 cadavers, 97 total feet were included in our analysis. Of these feet, 47 (48%) lacked a flexor digitorum brevis tendon to the fifth toe at all. Furthermore, 25 (26%) had notably small tendons to the fifth toe. The final 25 (26%) had what the researchers deemed present tendons. This information could be helpful in surgical planning, including tendon transfer techniques, and biomechanical evaluations. Further research would need to be conducted as this was a cadaveric study. Cadaver/anatomy research, Level V.

  1. [Developments in suture techniques of hand flexor tendon injuries during the last fifteen years].

    PubMed

    Bíró, Vilmos

    2016-02-07

    In the reconstruction of hand flexor tendon injuries it is fundamental to select the best suture technique, which makes possible early, active postoperative mobilization and achievement of the best results. The author reviews the development of suture techniques of the flexor tendon injuries during the last fifteen years, and discusses experimental tendon reconstruction results as well as clinical outcomes. The author describes the importance of different tendon suture materials, the significance of the pulley system of the fingers, the stretching between the sutured tendon ends by tendon sutures and, finally, the importance of the moving course in the reconstructed tendon. He states, that the wide-range adoption of the discussed modern tendon sutures would be necessary for better postoperative results.

  2. Zone 2 lacerations of both flexor tendons of all fingers in the same patient.

    PubMed

    Al-Qattan, M M

    2011-03-01

    Over an eight-year period, the author has treated five males (mean age of 31 years) with clean-cut zone 2 lacerations of both flexor tendons of all fingers using the same surgical technique (profundus only repair using three 'figure of eight' core sutures and proximal venting of the pulley system) and the same postoperative mobilization programme (a dorsal blocking splint with immediate active motion that allowed full extension at the interphalangeal joints). There were no ruptures of the repaired 20 fingers. At final follow-up (mean of 22 months after surgery), the outcome was considered excellent in 12 fingers, good in four fingers and fair in the remaining four fingers by the Strickland-Glogovac criteria. The outcome was similar in all four fingers for every patient supporting the hypothesis of previous studies that the outcome of repair of clean-cut flexor tendon lacerations in zone 2 is related to the psychological and biologic characteristics of the patient.

  3. Volar plate position and flexor tendon rupture following distal radius fracture fixation.

    PubMed

    Kitay, Alison; Swanstrom, Morgan; Schreiber, Joseph J; Carlson, Michelle G; Nguyen, Joseph T; Weiland, Andrew J; Daluiski, Aaron

    2013-06-01

    To determine whether there were differences between plate position in patients who had postoperative flexor tendon ruptures following volar plate fixation of distal radius fractures and those who did not. Three blinded reviewers measured the volar plate prominence and position on the lateral radiographs of 8 patients treated for flexor tendon ruptures and 17 matched control patients without ruptures following distal radius fracture fixation. We graded plate prominence using the Soong grading system, and we measured the distances between the plate and both the volar critical line and the volar rim of the distal radius. A higher Soong grade was associated with flexor tendon rupture. Patients with ruptures had plates that were more prominent volarly and more distal than matched controls without ruptures. Plate prominence projecting greater than 2.0 mm volar to the critical line had a sensitivity of 0.88, a specificity of 0.82, and positive and negative predictive values of 0.70 and 0.93, respectively, for tendon ruptures. Plate position distal to 3.0 mm from the volar rim had a sensitivity of 0.88, a specificity of 0.94, and positive and negative predictive values of 0.88 and 0.94, respectively, for tendon ruptures. We identified plate positions associated with attritional flexor tendon rupture following distal radius fracture fixation with volar plates. To decrease rupture risk, we recommend considering elective hardware removal after union in symptomatic patients with plate prominence greater than 2.0 mm volar to the critical line or plate position within 3.0 mm of the volar rim. Therapeutic III. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Effects of Non-Steroidal Anti-Inflammatory Drugs on Flexor Tendon Rehabilitation after Repair

    PubMed Central

    Rouhani, Alireza; Tabrizi, Ali; Ghavidel, Ehsan

    2013-01-01

    Background: Peritendinous adhesions after repairing an injury to the digital flexor tendons are a major problem in hand surgery. Non-steroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The aim of this study was to evaluate ibuprofen effect in patients function after flexor tendon surgical repair. Method: Thirty-five patients, who had sharp-edge lacerations of hand-zone II requiring flexor tendons repair, participated in this randomized double-blind clinical trial study. The patients were randomly classified into two parallel and matched groups (21 patients in the intervention group and 14 patients in the control group). The groups were matched considering age, gender, and laceration size. The control group received a placebo with the same appearance and dosage. In the intervention group, ibuprofen was prescribed at a high dosage (2400 mg/day). The range of motion improvement rate of the involved fingers and the patients’ performance after their follow-up period were compared. Results: There was a statistically significant difference between the two groups for range of motion of the involved finger joints (P=0.03). According to the DASH score, there was a statistically significant difference between the final performance of the patients, such that it was 11±2.4 and 18.4±6.3 in the intervention and control groups, respectively (P=0.01). There was not any case of re-tear or need to re-operate in the intervention and control groups. Conclusion: Our findings reveal that ibuprofen with an anti-inflammatory dose was effective in improving the range of motion of the involved fingers joints after flexor tendon injury. PMID:25207280

  5. The influence of patient insurance status on access to outpatient orthopedic care for flexor tendon lacerations.

    PubMed

    Draeger, Reid W; Patterson, Brendan M; Olsson, Erik C; Schaffer, Alicia; Patterson, J Megan M

    2014-03-01

    To determine the effect of patient insurance status on access to outpatient orthopedic care for acute flexor tendon lacerations. The research team contacted 100 randomly chosen orthopedic surgery practices in North Carolina by phone on 2 different occasions separated by 3 weeks. The research team attempted to obtain an appointment for a fictitious 28-year-old man with an acute flexor tendon laceration. Insurance status was presented as Medicaid in 1 call and private insurance in the other call. Ability of an office to schedule an appointment was recorded. Of the 100 practices, 13 were excluded because they did not perform hand surgery, which left 87 practices. The patient in the scenario with Medicaid was offered an appointment significantly less often (67%) than the patient in the scenario with private insurance (82%). The odds of the patient with private insurance obtaining an appointment were 2.2 times greater than the odds of the Medicaid patient obtaining an appointment. The Medicaid patient was more likely not to be offered an appointment owing to the lack of a hand surgeon at a practice (28% of appointment denials) than privately insured patients (13% of appointment denials). For patients with acute flexor tendon lacerations, insurance status has an important role in the ability to obtain an orthopedic clinic appointment. We found that patients with Medicaid have more barriers to accessing care for a flexor tendon laceration than patients with private insurance. Prognostic II. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. A rare case of an accessory flexor hallucis longus causing tarsal tunnel syndrome.

    PubMed

    Lin, D; Williams, C; Zaw, H

    2014-09-01

    Tarsal tunnel syndrome (TTS) is a rare entrapment neuropathy of the tibial nerve within the fibro-osseous tarsal tunnel for which multiple etiologies, including trauma, congenital foot abnormalities and space occupying lesions, have been described. We present an unusual case of TTS caused by an accessory Flexor Hallucis Longus (FHL) tendon. Surgical excision led to a complete resolution of symptoms and improved the quality of life of our patient.

  7. Differential Effects of Unilateral Concentric Vs. Eccentric Exercise on the Dominant and Nondominant Forearm Flexors.

    PubMed

    Beck, Travis W; Ye, Xin; Wages, Nathan P

    2016-03-01

    The purpose of this study was to compare the electromyographic (EMG) intensity patterns after unilateral concentric vs. eccentric exercise in the dominant (DOM) and nondominant (NONDOM) forearm flexors. Twenty-six men (mean ± SD: age, 24.0 ± 3.7 years) volunteered to perform a maximal isometric muscle action of the DOM and NONDOM forearm flexors before (PRE) and immediately after (POST) a series of maximal concentric isokinetic or maximal eccentric isokinetic muscle actions of the DOM forearm flexors. The concentric isokinetic and eccentric isokinetic muscle actions were performed on separate days that were randomly ordered. However, in both cases, the subjects performed 6 sets of 10 maximal muscle actions. A bipolar surface EMG signal was detected from the biceps brachii of the DOM and NONDOM limbs during the PRE and POST isometric muscle actions. The signals were then analyzed with a wavelet analysis, and the resulting intensity patterns were classified with a paired pattern classification procedure. The results indicated that the EMG intensity patterns could be correctly classified into their respective PRE vs. POST categories with an accuracy rate that was significantly better than random (20 of 26 patterns = 76.9% accuracy) but only for the DOM limb following the eccentric muscle actions. All other classifications were not significantly better than random. These findings indicated that eccentric exercise had a significant influence on the muscle activation pattern for the forearm flexors. It is possible that the muscle damage resulting from eccentric exercise affects muscle spindle or golgi tendon organ or both activity, thereby altering the muscle activation pattern.

  8. Isokinetic Evaluation of the Hip Flexor and Extensor Muscles: A Systematic Review.

    PubMed

    Zapparoli, Fabricio Yuri; Riberto, Marcelo

    2016-12-19

    Isokinetic dynamometry testing is a safe and reliable method accepted as the "gold standard" in the evaluation of muscle strength in the open kinetic chain. Isokinetic hip examinations face problems in the standardization of the position of the equipment axis; in the individual being examined; in the adjustment of the lever arm and in stabilization strategies for the patients during the tests. Identification of the methodologic procedures with best reproducibility is also needed. The objective of this study was to review the literature to evaluate the parameters used for the isokinetic evaluation of the hip flexor and extensor muscles and its reproducibility. This is a systematic literature review of the Cochrane, LILACS, PEDro, PubMed, and SciELO databases. The inclusion criteria were papers on the evaluation of hip flexor and/or extensor muscular strength with an isokinetic dynamometer and papers that analyzed the ICC or Pearson's reproducibility. The information extracted was: positioning of the patient; positioning of the dynamometer axis; positioning of the lever arm; angular speed; sample size, pathology; type of contraction and ICC and Pearson's results. On the databases 204 papers were found, from which 14 were selected that evaluated hip flexor and extensor muscles, involving 550 individuals who were submitted to an isokinetic hip evaluation. Five papers obtained the best result in reproducibility and had their methodology analyzed. In order to obtain better reproducibility of the isokinetic evaluation of the hip flexor and extensor muscles, the following recommendations must be followed: the individual must be positioned in the supine position and the dynamometer axis must be aligned with the greater trochanter of the femur. The positioning of the lever arm must be in the most distal region of the thigh possible. The angular speed used to analyze torque peak and muscle work was 60°/s, and to evaluate the muscle power it was 180°/s, with concentric and

  9. Giant cell tumor of the flexor hallucis longus tendon sheath: a case study.

    PubMed

    Findling, Jeff; Lascola, Natalie K; Groner, Thomas W

    2011-01-01

    Giant cell tumor of tendon sheath is infrequently documented in the foot and even less near the ankle. This case report involves such a tumor of the flexor hallucis longus tendon presenting at the posterior ankle. Diagnosis was aided by magnetic resonance imaging, and treatment consisted of complete surgical excision. Pathologic examination verified the diagnosis of giant cell tumor of tendon sheath, and follow-up magnetic resonance imaging revealed no remnants or recurrence of tumor 1 year after surgery.

  10. A comparison of tenocytes and mesenchymal stem cells for use in flexor tendon tissue engineering.

    PubMed

    Kryger, Gil S; Chong, Alphonsus K S; Costa, Melinda; Pham, Hung; Bates, Steven J; Chang, James

    2007-01-01

    Tissue-engineered tendon grafts will meet an important clinical need. To engineer tendons, we used acellularized allogeneic tendon as scaffold material. To determine the ideal cell type to seed the scaffolds, we studied in vitro characteristics of epitenon tenocytes, tendon sheath fibroblasts, bone marrow-derived mesenchymal stem cells (BMSCs), and adipoderived mesenchymal stem cells (ASCs). Subsequently, we implanted reseeded acellularized tendons in vivo as flexor tendon grafts. Tenocytes, sheath fibroblasts, BMSCs, and ASCs were obtained from adult rabbits. For all cell lines, collagen 1, 2, and 3 immunocytochemistry was performed, and proliferation was assessed by hemacytometry and senescence by beta-galactosidase staining. Flexor tendons were acellularized after harvest. Tendons were assessed by histology after in vitro reseeding with each of the cell types after 1, 4, and 8 weeks. Finally, reseeded tendons and controls were implanted in a flexor profundus tendon defect. After 6 weeks, the reseeded tendons were harvested and assessed by histology. Statistical analysis for cell proliferation was performed using analysis of variance and t-tests with Bonferroni correction. All cell types had similar collagen expression. Cell proliferation was higher in ASCs in late passage compared with early passage and in ASCs compared with epitenon tenocytes at late passage. The other cell types were similar in growth characteristics. No senescence was detected. In vitro assessment of reseeded constructs showed the presence of cells on the construct surface. In vivo assessment after implantation showed viable cells seen within the tendon architecture in all cell types. This study suggests that the four cell types may be successfully used to engineer tendons. Adipoderived mesenchymal stem cells proliferate faster in cell culture, but the cell types were similar in other respects. All could be used to successfully repopulate acellularized tendon in vivo as flexor tendon grafts.

  11. Hip flexor muscle size, strength and recruitment pattern in patients with acetabular labral tears compared to healthy controls.

    PubMed

    Mendis, M Dilani; Wilson, Stephen J; Hayes, David A; Watts, Mark C; Hides, Julie A

    2014-10-01

    Acetabular labral tears are a source of hip pain and are considered to be a precursor to hip osteoarthritis. Hip flexor muscles contribute to hip joint stability and function but it is unknown if their size and function is altered in the presence of labral pathology. This study aimed to investigate hip flexor muscle size, strength and recruitment pattern in patients with hip labral pathology compared to control subjects. 12 subjects diagnosed with an unilateral acetabular labral tear were compared to 12 control subjects matched for age and gender. All subjects underwent magnetic resonance imaging (MRI) of their lumbo-pelvic region. Average muscle cross-sectional area (CSA) of the iliacus, psoas, iliopsoas, sartorius, tensor fascia latae and rectus femoris muscles were measured. Hip flexion strength was measured by an externally fixed dynamometer. Individual muscle recruitment pattern during a resisted hip flexion exercise task was measured by muscle functional MRI. Hip flexor muscle strength was found to be decreased in patients with labral pathology compared to control subjects (p < 0.01). No difference between groups or sides was found for hip flexor muscle size (all p > 0.17) and recruitment pattern (all p > 0.53). Decreased hip flexor muscle strength may affect physical function in patients with hip labral pathology by contributing to altered gait patterns and functional tasks. Clinical rehabilitation of these patients may need to include strengthening exercises for the hip flexor muscles. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. The prevalence of accessory heads of the flexor pollicis longus and the flexor digitorum profundus muscles in Egyptians and their relations to median and anterior interosseous nerves.

    PubMed

    El Domiaty, M A; Zoair, M M; Sheta, A A

    2008-02-01

    Entrapment neuropathy in the forearm is not uncommon. Surgical interference for nerve decompression should be preceded by accurate diagnosis of the exact cause and site of the nerve entrapment. The aim of the present study was to investigate the prevalence of accessory heads of the flexor pollicis longus and flexor digitorum profundus muscles (FPLah) and (FDPah) in Egyptians and their topographical relationship with both the median nerve and its anterior interosseous branch. A total of 42 upper limbs of embalmed cadavers, 36 from males and 6 from females, were examined to elucidate the prevalence of both the FPLah and the FDPah muscles, their origin, insertion, nerve supply and morphology. The distribution of these two muscles in the right and left male and female upper limbs and their relationship to the anterior interosseous and median nerves were recorded. The total lengths of both accessory muscles and the lengths of their fleshy bellies and tendons were also measured. The FPLah was found to be present more frequently (61.9%) than it was absent, whereas the FDPah was observed in only 14.24% of the specimens examined. The combination of the accessory muscles in the same forearm was noticed in 9.52% of cases. As regards side, the FPLah appeared in 77.7% of the right forearms and in 50% of the left, while the FDPah was found in only 25% of the left forearms. The accessory muscles showed no single morphology, as the FPLah appeared fusiform in 53.8%, slender in 30.8% and voluminous fusiform in 15.4%, while the FDPah was slender in 66.6% and triangular in 33.3% of specimens. The FPLah arose mainly from the under surface of flexor digitorum superficialis, while the FDPah took its origin from the under surface of flexor digitorum superficialis or from the medial epicondyle. The insertion of the FPLah was mainly into the upper third of the FPL tendon, while the FDPah tendon joined the tendons of the flexor digitorum profundus muscle to the index or middle and ring

  13. Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair

    NASA Astrophysics Data System (ADS)

    Ayad, K. E.; El Gohary, H. M.; Abd Elrahman, M.; Abd El Mejeed, S. F.; Bekheet, A. B.

    2009-09-01

    Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.

  14. Friction between human finger flexor tendons and pulleys at high loads.

    PubMed

    Schweizer, A; Frank, O; Ochsner, P E; Jacob, H A C

    2003-01-01

    A method was developed to indirectly measure friction between the flexor tendons and pulleys of the middle and ring finger in vivo. An isokinetic movement device to determine maximum force of wrist flexion, interphalangeal joint flexion (rolling in and out) and isolated proximal interphalangeal (PIP) joint flexion was built. Eccentric and concentric maximum force of these three different movements where gliding of the flexor tendon sheath was involved differently (least in wrist flexion) was measured and compared. Fifty-one hands in 26 male subjects were evaluated. The greatest difference between eccentric and concentric maximum force (29.9%) was found in flexion of the PIP joint. Differences in the rolling in and out movement (26.8%) and in wrist flexion (14.5%) were significantly smaller. The force of friction between flexor tendons and pulleys can be determined by the greater difference between eccentric and concentric maximum force provided by the same muscles in overcoming an external force during flexion of the interphalangeal joints and suggests the presence of a non-muscular force, such as friction. It constitutes of 9% of the eccentric flexion force in the PIP joint and therefore questions the low friction hypothesis at high loads. Copyright 2002 Elsevier Science Ltd.

  15. Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair

    SciTech Connect

    Ayad, K. E.; Abd El Mejeed, S. F.; El Gohary, H. M.; Abd Elrahman, M.; Bekheet, A. B.

    2009-09-27

    Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.

  16. Differential Strength and Endurance Parameters of the Craniocervical and Cervicothoracic Extensors and Flexors in Healthy Individuals.

    PubMed

    O'Leary, Shaun; Fagermoen, Charlotte Loraas; Hasegawa, Hiroyuki; Thorsen, Ann-Sofi Slettevold; Van Wyk, Luke

    2017-04-01

    This study examined isometric strength (maximal voluntary contraction [MVC]) and endurance of cervical flexor and extensor muscles in healthy individuals at the craniocervical (CC) and cervicothoracic (CT) axes. MVC and endurance measures (time to task failure in seconds [s]) at 50% MVC were recorded in 4 directions (CC flexion, CC extension, CT flexion, and CT extension) in 20 males and 20 females, and 6 strength and endurance ratios were calculated. The findings showed that the cervical extensor muscles are not only much stronger than the flexors (1.3-2 times greater MVC), but also have greater capacity for endurance (2-2.4 times greater). While males produced significantly greater MVC recordings than females (P < .003), strength ratios (P > .06) and endurance measures (P > .11) were similar. Endurance ratios were also similar except the CT extension to CC flexion ratio, which was significantly larger in females compared with males (P = .03). These findings demonstrate that substantial but normal variation exists in strength and endurance parameters between cervical flexor and extensor muscles. This is informative to clinicians when evaluating the performance of these neck muscles or when deciding on exercise parameters (eg, load, duration) when training their performance.

  17. The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties.

    PubMed

    Samukawa, Mina; Hattori, Masaki; Sugama, Naoko; Takeda, Naoki

    2011-12-01

    Dynamic stretching is commonly used in warm-up routines for athletic activities. Even though several positive effects of dynamic stretching on athletic performance have been reported, the effects on the muscle-tendon unit (MTU) itself are still unclear. The objective of this study is to determine the effects of dynamic stretching on the ankle plantar flexor muscle-tendon properties by use of ultrasonography. Twenty healthy male subjects participated in the present study. The subjects were asked to engage in dynamic stretching of plantar flexors for 30 s and to repeat for 5 sets. Ankle dorsiflexion ROM was measured before and after the dynamic stretching. Changes in the displacement of the myotendinous junction (MTJ), pennation angle, and fascicle length were also determined by using ultrasonography. Ankle dorsiflexion ROM increased significantly after the dynamic stretching (p < 0.0001). A significant distal displacement of the MTJ was observed until the second stretching set (p < 0.001) with no significant changes thereafter. Pennation angle, and fascicle length were unaffected by the dynamic stretching. Dynamic stretching was shown to be effective in increasing ankle joint flexibility. Outcomes that could have indicated changes in muscle tissue (such as the pennation angle and fascicle length) were unaltered. However, a significant displacement of the MTJ was found, indicating some change in the tendon tissues. Therefore, dynamic stretching of the plantar flexors was considered an effective means of lengthening the tendon tissues.

  18. Effects of Lubricant and Autologous Bone Marrow Stromal Cell Augmentation on Immobilized Flexor Tendon Repairs

    PubMed Central

    Zhao, Chunfeng; Ozasa, Yasuhiro; Shimura, Haruhiko; Reisdorf, Ramona L.; Thoreson, Andrew R.; Jay, Gregory; Moran, Steven L.; An, Kai-Nan; Amadio, Peter C.

    2016-01-01

    The purpose of the study was to test a novel treatment that carbodiimide-derivatized-hyaluronic acid-lubricin (cd-HA-lubricin) combined cell-based therapy in an immobilized flexor tendon repair in a canine model. Seventy-eight flexor tendons from 39 dogs were transected. One tendon was treated with cd-HA-lubricin plus an interpositional graft of 8 × 105 BMSCs and GDF-5. The other tendon was repaired without treatment. After 21 day of immobilization, 19 dogs were sacrificed; the remaining 20 dogs underwent a 21-day rehabilitation protocol before euthanasia. The work of flexion, tendon gliding resistance, and adhesion score in treated tendons were significantly less than the untreated tendons (p < 0.05). The failure strength of the untreated tendons was higher than the treated tendons at 21 and 42 days (p < 0.05). However, there is no significant difference in stiffness between two groups at day 42. Histologic analysis of treated tendons showed a smooth surface and viable transplanted cells 42 days after the repair, whereas untreated tendons showed severe adhesion formation around the repair site. The combination of lubricant and cell treatment resulted in significantly improved digit function, reduced adhesion formation. This novel treatment can address the unmet needs of patients who are unable to commence an early mobilization protocol after flexor tendon repair. PMID:26177854

  19. Home-based rehabilitation in the postoperative treatment of flexor tendon repair.

    PubMed

    Sanmartín-Fernández, M; Fernández-Bran, B; Couceiro-Otero, J

    To evaluate the results and complications of flexor tendon repair in which a home-based rehabilitation program was utilized without the assistance of a hand therapist during the first 4postoperative weeks. Between July 2009 and July 2014, a total of 21 digits in 15 patients were treated in our institution for complete laceration of the flexor tendons within the flexor pulley system (zone 1 and 2). Passive and active exercises performed by the patients themselves were started the morning after the operation. Data, as range-of-motion and complications, were collected 6months after the surgery. Fifteen digits had full recovery of flexion. One patient suffered a rupture in the fifth postoperative week. Ten of the 21 digits developed a flexion contracture of the proximal interphalangeal joint; in 5 the contracture was less or equal to 10° without impairment of function or aesthetics. Over recent decades, specialized hand therapy has been of great importance in the postoperative treatment of hand diseases. Unfortunately, these professionals are not always available in our area in the first days after surgery. With this protocol, the patient is in charge of carrying out the postoperative exercises, which could lead to a worse final result and a higher rate of complications. The home-based rehabilitation program yielded complete recovery of joint mobility in most cases with a low complication rate. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Does skin stimulation compensate impairments in postural control after ankle plantar flexors fatigue?

    PubMed

    Kunzler, Marcos R; Lopes, Liane M; Ueda, Letícia S; de Britto, Morgana A; Carpes, Felipe P

    2013-04-01

    It has been suggested that skin stimulation using tape glued to the skin over the Achilles tendon helps to improve postural control. It was recently shown that these effects might emerge only after muscle fatigue and not during non-fatigue standing. Here we tested the influence of skin stimulation on postural control before and after fatigue of ankle plantar flexors. Eighteen subjects stood quietly on a force plate while the center of pressure was monitored before and after fatigue of ankle plantar flexors muscles, with and without medical tape glued to the skin over the Achilles tendon. Our results suggested main effects of tape stimulation before fatigue (P<.05) and significant effect of tape stimulation after fatigue only for amplitude of center of pressure in the anteroposterior direction. The novelty of our study is that most of the center of pressure variables are improved by skin stimulation when the ankle plantar flexors are not fatigued. Therefore the benefits of tape stimulation during fatigue condition are questionable. Copyright © 2012 Elsevier B.V. All rights reserved.

  1. Gliding resistance of flexor tendon associated with carpal tunnel pressure: a biomechanical cadaver study.

    PubMed

    Zhao, Chunfeng; Ettema, Anke M; Berglund, Lawrence J; An, Kai-Nan; Amadio, Peter C

    2011-01-01

    The purpose of this study was to investigate the effect of carpal tunnel pressure on the gliding characteristics of flexor tendons within the carpal tunnel. Eight fresh human cadaver wrists and hands were used. A balloon was inserted into the carpal tunnel to elevate the pressure. The mean gliding resistance of the middle finger flexor digitorum superficialis tendon was measured with the following six conditions: (1) as a baseline, before balloon insertion; (2) balloon with 0 mmHg pressure; (3) 30 mmHg; (4) 60 mmHg; (5) 90 mmHg; (6) 120 mmHg. The gliding resistance of flexor tendon gradually increased as the carpal tunnel pressure was elevated. At pressures above 60 mmHg, the increase in gliding resistance became significant compared to the baseline condition. This study helps us to understand the relationship between carpal tunnel pressure, which is elevated in the patient with carpal tunnel syndrome (CTS) and tendon gliding resistance, which is a component of the work of flexion. These findings suggest that patients with CTS may have to expend more energy to accomplish specific motions, which may in turn affect symptoms of hand pain, weakness and fatigue, seen commonly in such patients. Copyright © 2010 Orthopaedic Research Society.

  2. Gliding Resistance of Flexor Tendon Associated with Carpal Tunnel Pressure: A Biomechanical Cadaver Study

    PubMed Central

    Zhao, Chunfeng; Ettema, Anke M.; Berglund, Lawrence J.; An, Kai-Nan; Amadio, Peter C.

    2010-01-01

    The purpose of this study was to investigate the effect of carpal tunnel pressure on the gliding characteristics of flexor tendons within the carpal tunnel. Eight fresh human cadaver wrists and hands were used. A balloon was inserted into the carpal tunnel to elevate the pressure. The mean gliding resistance of the middle finger flexor digitorum superficialis tendon was measured with the following six conditions 1) as a baseline, before balloon insertion; 2) balloon with 0 mmHg pressure; 3) 30 mmHg; 4) 60 mmHg; 5) 90 mmHg; 6) 120 mmHg. The gliding resistance of flexor tendon gradually increased as the carpal tunnel pressure was elevated. At pressures above 60 mmHg, the increase in gliding resistance became significant compared to the baseline condition. This study helps us to understand the relationship between carpal tunnel pressure, which is elevated in the patient with carpal tunnel syndrome (CTS) and tendon gliding resistance, which is a component of the work of flexion. These findings suggest that patients with CTS may have to expend more energy to accomplish specific motions, which may in turn affect symptoms of hand pain, weakness and fatigue, seen commonly in such patients. PMID:20661935

  3. Isokinetic muscle strength for ankle extensors and flexors: a comparison between elite sprint runners and swimmers.

    PubMed

    Ozçaldiran, B; Durmaz, B

    2008-09-01

    The aim of this study was to evaluate through isokinetic tests the muscular condition of ankles of elite sprint swimmers and elite sprint runners, and make comparisons within these groups. Fourteen elite swimmers and 8 elite runners were included in this cross-sectional study. The ankle extensors and flexors strength characteristics of elite sprinter athletes were tested at a slow (30 degrees/s) and a fast (120 degrees/s) speed using an isokinetic dynamometer. Subjects were assessed by one examiner on six separate days, within a 2-week period. A significant difference was noted between right and left sides for ankle joint flexors in runners at slow speed. Runners had higher left ankle flexion measures at 30 degrees/s and 120 degrees/s angular velocity than swimmers. There was no significant difference between the peak torques of the left and right sides at all angular velocities in swimmers. To our knowledge, this is the first study to assess the ankle flexors and extensors strength characteristics of elite sprinter swimmers making a comparison with elite sprinter runners. The findings presented in this study report the sport specific difference between the sprint swimmers and sprint runners. These values add a quantative dimension to rehabilitative and preventive sports medicine for elite sprinter runners and swimmers.

  4. The quantitative role of flexor sheath incision in correcting Dupuytren proximal interphalangeal joint contractures.

    PubMed

    Blazar, P E; Floyd, E W; Earp, B E

    2016-07-01

    Controversy exists regarding intra-operative treatment of residual proximal interphalangeal joint contractures after Dupuytren's fasciectomy. We test the hypothesis that a simple release of the digital flexor sheath can correct residual fixed flexion contracture after subtotal fasciectomy. We prospectively enrolled 19 patients (22 digits) with Dupuytren's contracture of the proximal interphalangeal joint. The average pre-operative extension deficit of the proximal interphalangeal joints was 58° (range 30-90). The flexion contracture of the joint was corrected to an average of 28° after fasciectomy. In most digits (20 of 21), subsequent incision of the flexor sheath further corrected the contracture by an average of 23°, resulting in correction to an average flexion contracture of 4.7° (range 0-40). Our results support that contracture of the tendon sheath is a contributor to Dupuytren's contracture of the joint and that sheath release is a simple, low morbidity addition to correct Dupuytren's contractures of the proximal interphalangeal joint. Additional release of the proximal interphalangeal joint after fasciectomy, after release of the flexor sheath, is not necessary in many patients. IV (Case Series, Therapeutic). © The Author(s) 2015.

  5. Electromyography of wrist and finger flexor muscles in olive baboons (Papio anubis).

    PubMed

    Patel, Biren A; Larson, Susan G; Stern, Jack T

    2012-01-01

    Some non-human primates use digitigrade hand postures when walking slowly on the ground. As a component of an extended limb, a digitigrade posture can help minimize wrist joint moments thereby requiring little force production directly from wrist flexors (and/or from the assistance of finger flexors) to maintain limb posture. As a consequence, less active muscle volume would be required from these anti-gravity muscles and overall metabolic costs associated with locomotion could be reduced. To investigate whether the use of digitigrade hand postures during walking in primates entails minimal use of anti-gravity muscles, this study examined electromyography (EMG) patterns in both the wrist and finger flexor muscles in facultatively digitigrade olive baboons (Papio anubis) across a range of speeds. The results demonstrate that baboons can adopt a digitigrade hand posture when standing and moving at slow speeds without requiring substantial EMG activity from distal anti-gravity muscles. Higher speed locomotion, however, entails increasing EMG activity and is accompanied by a dynamic shift to a more palmigrade-like limb posture. Thus, the ability to adopt a digitigrade hand posture by monkeys is an adaptation for ground living, but it was never co-opted for fast locomotion. Rather, digitigrady in primates appears to be related to energetic efficiency for walking long distances.

  6. Isokinetic Evaluation of Knee Extensor/Flexor Muscle Strength in Behcet's Patients.

    PubMed

    Durmus, Bekir; Emre, Sinan; Sahin, Nilay; Karincaoglu, Yelda; Dogan, Erdal; Baysal, Ozlem; Ersoy, Yuksel; Altay, Zuhal

    2014-08-24

    Background: Behçet's disease (BD) is an idiopathic, multisystemic, progressive disease. The purpose of this study is to compare the knee flexor and extensor isokinetic muscle strengths of Behcet's patients with that of healthy subjects. Methods: Twenty-five (13 male and 12 female) patients with BD and 25 (15 male and 10 female) healthy individuals were included in the study. Velocities of 90°/sec, 120°/sec, and 150°/sec were used for the isokinetic muscle strength testing. Patients with active inflammatory knee arthritis were excluded. Peak torque (Nm) and peak torque adjusted to body weight (%) were taken into consideration for comparison between study groups. Results: Compared to healthy controls, there was a statistically significant decrease in both the bilateral knee extensor and flexor muscle isokinetic peak torques(Nm) as well as the peak torques adjusted to body weight (%) at velocities of 90°/sec, 120°/sec and 150°/sec in patients with BD (p < 0.05). However, there was no significant difference in the agonist-antagonist ratio of the isokinetic peak torques of knee muscles between the two groups. Conclusion: In light of these findings, we have concluded that both knee flexor and extensor isokinetic muscle strengths are lower in BD. We therefore recommend careful monitoring of patients with BD in terms of muscle strength.

  7. Isokinetic Evaluation of Knee Extensor/Flexor Muscle Strength in Behcet's Patients.

    PubMed

    Durmus, B; Emre, S; Sahin, N; Karincaoglu, Y; Dogan, E; Baysal, O; Ersoy, Y; Altay, Z

    2015-01-01

    Behçet's disease (BD) is an idiopathic, multisystemic, progressive disease. The purpose of this study is to compare the knee flexor and extensor isokinetic muscle strengths of Behcet's patients with that of healthy subjects. Twenty-five (13 male and 12 female) patients with BD and 25 (15 male and 10 female) healthy individuals were included in the study. Velocities of 90°/sec, 120°/sec, and 150°/sec were used for the isokinetic muscle strength testing. Patients with active inflammatory knee arthritis were excluded. Peak torque (Nm) and peak torque adjusted to body weight (%) were taken into consideration for comparison between study groups. Compared to healthy controls, there was a statistically significant decrease in both the bilateral knee extensor and flexor muscle isokinetic peak torques(Nm) as well as the peak torques adjusted to body weight (%) at velocities of 90°/sec, 120°/sec and 150°/sec in patients with BD (p < 0.05). However, there was no significant difference in the agonist-antagonist ratio of the isokinetic peak torques of knee muscles between the two groups. In light of these findings, we have concluded that both knee flexor and extensor isokinetic muscle strengths are lower in BD. We therefore recommend careful monitoring of patients with BD in terms of muscle strength.

  8. Direct end-to-end repair of flexor pollicis longus tendon lacerations.

    PubMed

    Nunley, J A; Levin, L S; Devito, D; Goldner, R D; Urbaniak, J R

    1992-01-01

    Between 1976 and 1986, 38 consecutive acute isolated flexor pollicis longus lacerations were repaired. This study excluded all replanted or mutilated digits and all lacerations with associated fracture. Average follow-up was 26 months. Tendon rehabilitation was standardized. Range of motion and pinch strength were measured postoperatively. Seventy-four percent (28/38) of the flexor pollicis longus injuries occurred in zone II. Neurovascular injury occurred in 82% of the lacerations, and this correlated with the zone of tendon injury. In 21% of the patients (8/38) both digital nerves and arteries were transected. Postoperative thumb interphalangeal motion averaged 35 degrees and key pinch strength was 81% that of the uninjured thumb. One rupture occurred in a child. Laceration of the flexor pollicis longus is likely to involve damage to neurovascular structures, and repair may be necessary. Direct end-to-end repairs within the pulley system do at least as well as delayed tendon reconstruction and do not require additional procedures.

  9. Isometric endurance test of the cervical flexor muscles - Reliability and normative reference values.

    PubMed

    Ylinen, Jari; Salo, Petri; Järvenpää, Salme; Häkkinen, Arja; Nikander, Riku

    2017-07-01

    To obtain reference values for the isometric endurance test (IET) of the cervical flexor muscles, investigate its reproducibility, and compare the results with the maximal isometric strength test (MIST) of the cervical flexor muscles. Cross-sectional non-comparative study with single group repeated measurements. Altogether 219 healthy females aged 20-59 years volunteered to participate in the study. The IET was performed in the supine position and MIST seated. The reproducibility was evaluated by the intraclass correlation coefficient (ICC) and an analysis described by Bland and Altman. The relationship between the two measuring methods was evaluated by Pearson's correlation coefficient. The mean (SD) IET time was 60 (33) seconds with no significant differences between the age groups of each decade. The ICC for intrarater repeatability was 0.80. However, the Bland-Altman analysis suggested moderate variation in repeated measurements. Pearson's correlation coefficient between the IET and MIST was 0.56. Normative reference values for the IET are presented. Although the ICC showed good repeatability, one should consider that the change at follow-up visits has to be considerable to be clinically relevant. The correlation between the endurance time and maximal flexion strength was moderate. Thus IET of the cervical flexor muscles may be used in the clinic like the Biering-Sorenson test has been used to assess fatigue of the trunk extensor muscles. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Analysis of a knotless flexor tendon repair using a multifilament stainless steel cable-crimp system.

    PubMed

    Gordon, Leonard; Matsui, Jun; McDonald, Erik; Gordon, Joshua A; Neimkin, Ronald

    2013-04-01

    To compare the biomechanical and technical properties of flexor tendon repairs using a 4-strand cruciate FiberWire (FW) repair and a 2-strand multifilament stainless steel (MFSS) single cross-lock cable-crimp system. Eight tests were conducted for each type of repair using cadaver hand flexor digitorum profundus tendons. We measured the required surgical exposure, repair time, and force of flexion (friction) with a custom motor system with an inline load cell and measured ultimate tensile strength (UTS) and 2-mm gap force on a servo-hydraulic testing machine. Repair time averaged less than 7 minutes for the 2-strand MFSS cable crimp repairs and 12 minutes for the FW repairs. The FW repair was performed with 2 cm of exposure and removal of the C-1 and A-3 pulleys. The C-1 and A-3 pulleys were retained in each of the MFSS cable crimp repairs with less than 1 cm of exposure. Following the FW repair, the average increase in friction was 89% compared with an average of 53% for the MFSS repairs. Six of the 8 MFSS specimens achieved the UTS before any gap had occurred, whereas all of the FW repairs had more than 2 mm of gap before the UTS, indicating that the MFSS was a stiffer repair. The average UTS appeared similar for both groups. We describe a 2-strand multifilament stainless steel single cross-lock cable crimp flexor repair system. In our studies of this cable crimp system, we found that surgical exposure, average repair times, and friction were reduced compared to the traditional 4-strand cruciate FW repair. While demonstrating these benefits, the crimp repair also produced a stiff construct and high UTS and 2-mm gap force. A cable crimp flexor tendon repair may offer an attractive alternative to current repair methods. The benefits may be important especially for flexor tendon repair in zone 2 or for the repair of multiple tendons. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. Combined flexor-pronator mass and ulnar collateral ligament injuries in the elbows of older baseball players.

    PubMed

    Osbahr, Daryl C; Swaminathan, Swarup S; Allen, Answorth A; Dines, Joshua S; Coleman, Struan H; Altchek, David W

    2010-04-01

    Ulnar collateral ligament reconstruction techniques have afforded baseball players up to a reported 90% return to prior or higher level of play. A subpopulation exists with less impressive clinical outcomes potentially related to the presence of a concomitant flexor-pronator mass injury. Combined flexor-pronator and ulnar collateral ligament injuries occur in older players, and results in this group are inferior to those reported for isolated ulnar collateral ligament reconstructions. Case Series; Level of evidence, 4. All baseball players who had ulnar collateral ligament reconstructions by 1 surgeon over a 6-year period were identified, and the authors studied those treated for a combined flexor-pronator and ulnar collateral ligament injury. The ulnar collateral ligament reconstruction was accomplished using the docking technique, and the flexor-pronator injury was treated with debridement if tendinotic or reattachment if torn. A 2-sample t test was conducted to evaluate the likelihood of developing the combined flexor-pronator/ulnar collateral ligament compared with ulnar collateral ligament injury based on age, while a Pearson chi(2) test was used to evaluate the likelihood of a patient being > or =30 years of age in the combined flexor-pronator/ulnar collateral ligament versus ulnar collateral ligament groups. Outcome was assessed using a modified Conway classification. A total of 187 male baseball players between 14 and 42 years of age (mean, 20.7 years) had an ulnar collateral ligament reconstruction by 1 surgeon. Eight (4%) of 187 baseball players were treated for the combined flexor-pronator/ulnar collateral ligament injury. There was a statistically significant difference in age between the ulnar collateral ligament group (20.1 years) and the flexor-pronator/ulnar collateral ligament group (33.4 years) (P < .001). Age > or =30 years was a statistically significant age limit to predict the presence of a combined flexor-pronator/ulnar collateral ligament

  12. The revitalisation of flexor tendon allografts with bone marrow stromal cells and mechanical stimulation: An ex vivo model revitalising flexor tendon allografts.

    PubMed

    Wu, J H; Thoreson, A R; Gingery, A; An, K N; Moran, S L; Amadio, P C; Zhao, C

    2017-03-01

    The present study describes a novel technique for revitalising allogenic intrasynovial tendons by combining cell-based therapy and mechanical stimulation in an ex vivo canine model. Specifically, canine flexor digitorum profundus tendons were used for this study and were divided into the following groups: (1) untreated, unprocessed normal tendon; (2) decellularised tendon; (3) bone marrow stromal cell (BMSC)-seeded tendon; and (4) BMSC-seeded and cyclically stretched tendon. Lateral slits were introduced on the tendon to facilitate cell seeding. Tendons from all four study groups were distracted by a servohydraulic testing machine. Tensile force and displacement data were continuously recorded at a sample rate of 20 Hz until 200 Newton of force was reached. Before testing, the cross-sectional dimensions of each tendon were measured with a digital caliper. Young's modulus was calculated from the slope of the linear region of the stress-strain curve. The BMSCs were labeled for histological and cell viability evaluation on the decellularized tendon scaffold under a confocal microscope. Gene expression levels of selected extracellular matrix tendon growth factor genes were measured. Results were reported as mean ± SD and data was analyzed with one-way ANOVAs followed by Tukey's post hoc multiple-comparison test. We observed no significant difference in cross-sectional area or in Young's modulus among the four study groups. In addition, histological sections showed that the BMSCs were aligned well and viable on the tendon slices after two-week culture in groups three and four. Expression levels of several extracellular matrix tendon growth factors, including collagen type I, collagen type III, and matrix metalloproteinase were significantly higher in group four than in group three (p < 0.05). Lateral slits introduced into de-cellularised tendon is a promising method of delivery of BMSCs without compromising cell viability and tendon mechanical properties. In addition

  13. Anodal transcranial direct current stimulation of the motor cortex induces opposite modulation of reciprocal inhibition in wrist extensor and flexor.

    PubMed

    Lackmy-Vallée, Alexandra; Klomjai, Wanalee; Bussel, Bernard; Katz, Rose; Roche, Nicolas

    2014-09-15

    Transcranial direct current stimulation (tDCS) is used as a noninvasive tool to modulate brain excitability in humans. Recently, several studies have demonstrated that tDCS applied over the motor cortex also modulates spinal neural network excitability and therefore can be used to explore the corticospinal control acting on spinal neurons. Previously, we showed that reciprocal inhibition directed to wrist flexor motoneurons is enhanced during contralateral anodal tDCS, but it is likely that the corticospinal control acting on spinal networks controlling wrist flexors and extensors is not similar. The primary aim of the study was to explore the effects of anodal tDCS on reciprocal inhibition directed to wrist extensor motoneurons. To further examine the supraspinal control acting on the reciprocal inhibition between wrist flexors and extensors, we also explored the effects of the tDCS applied to the ipsilateral hand motor area. In healthy volunteers, we tested the effects induced by sham and anodal tDCS on reciprocal inhibition pathways innervating wrist muscles. Reciprocal inhibition directed from flexor to extensor muscles and the reverse situation, i.e., reciprocal inhibition, directed from extensors to flexors were studied in parallel with the H reflex technique. Our main finding was that contralateral anodal tDCS induces opposing effects on reciprocal inhibition: it decreases reciprocal inhibition directed from flexors to extensors, but it increases reciprocal inhibition directed from extensors to flexors. The functional result of these opposite effects on reciprocal inhibition seems to favor wrist extension excitability, suggesting an asymmetric descending control onto the interneurons that mediate reciprocal inhibition.

  14. Parallel reflex pathways from flexor muscle afferents evoking resetting and flexion enhancement during fictive locomotion and scratch in the cat.

    PubMed

    Stecina, Katinka; Quevedo, Jorge; McCrea, David A

    2005-11-15

    Reflex actions of muscle afferents in hindlimb flexor nerves were examined on ipsilateral motoneurone activity recorded in peripheral nerves during midbrain stimulation-evoked fictive locomotion and during fictive scratch in decerebrate cats. Trains of stimuli (15-30 shocks at 200 Hz) were delivered during the flexion phase at intensities sufficient to activate both group I and II afferents (5 times threshold, T). In many preparations tibialis anterior (TA) nerve stimulation terminated ongoing flexion and reset the locomotor cycle to extension (19/31 experiments) while extensor digitorum longus (EDL) stimulation increased and prolonged the ongoing flexor phase activity (20/33 preparations). The effects of sartorius, iliopsoas and peroneus longus muscle afferent stimulation were qualitatively similar to those of EDL nerve. Resetting to extension was seen only with higher intensity stimulation (5T) while ongoing flexor activity was often enhanced at group I intensity (2T) stimulation. The effects of flexor nerve stimulation were qualitatively similar during fictive scratch. Reflex reversals were consistently observed in some fictive locomotor preparations. In those cases, EDL stimulation produced a resetting to extension and TA stimulation prolonged the ongoing flexion phase. Occasionally reflex reversals occurred spontaneously during only one of several stimulus presentations. The variable and opposite actions of flexor afferents on the locomotor step cycle indicate the existence of parallel spinal reflex pathways. A hypothetical organization of reflex pathways from flexor muscle afferents to the spinal pattern generator networks with competing actions of group I and group II afferents on the flexor and extensor portions of this central circuitry is proposed.

  15. Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players.

    PubMed

    Chalker, Wade J; Shield, Anthony J; Opar, David A; Keogh, Justin W L

    2016-01-01

    Background. There has been a continual increase in injury rates in cricket, with hamstring strain injuries (HSIs) being the most prominent. Eccentric knee flexor weakness and bilateral asymmetries are major modifiable risk factors for future HSIs. However, there is a lack of data relating to eccentric hamstring strength in cricket at any skill level. The objective of this study was to compare eccentric knee flexor strength and bilateral asymmetries in elite, sub-elite and school level cricket players; and to determine if playing position and limb role influenced these eccentric knee flexor strength indices. Methods. Seventy four male cricket players of three distinct skill levels performed three repetitions of the Nordic hamstring exercise on the experimental device. Strength was assessed as the absolute and relative mean peak force output for both limbs, with bilateral asymmetries. Differences in mean peak force outputs between skill level and playing positions were measured. Results. There were no significant differences between elite, sub-elite and school level athletes for mean peak force and bilateral asymmetries of the knee flexors. There were no significant differences observed between bowler's and batter's mean peak force and bilateral asymmetries. There were no significant differences between front and back limb mean peak force outputs. Discussion. Skill level, playing position and limb role appeared to have no significant effect on eccentric knee flexor strength and bilateral asymmetries. Future research should seek to determine whether eccentric knee flexor strength thresholds are predictive of HSIs in cricket and if specific eccentric knee flexor strengthening can reduce these injuries.

  16. Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players

    PubMed Central

    Chalker, Wade J.; Shield, Anthony J.; Opar, David A.

    2016-01-01

    Background. There has been a continual increase in injury rates in cricket, with hamstring strain injuries (HSIs) being the most prominent. Eccentric knee flexor weakness and bilateral asymmetries are major modifiable risk factors for future HSIs. However, there is a lack of data relating to eccentric hamstring strength in cricket at any skill level. The objective of this study was to compare eccentric knee flexor strength and bilateral asymmetries in elite, sub-elite and school level cricket players; and to determine if playing position and limb role influenced these eccentric knee flexor strength indices. Methods. Seventy four male cricket players of three distinct skill levels performed three repetitions of the Nordic hamstring exercise on the experimental device. Strength was assessed as the absolute and relative mean peak force output for both limbs, with bilateral asymmetries. Differences in mean peak force outputs between skill level and playing positions were measured. Results. There were no significant differences between elite, sub-elite and school level athletes for mean peak force and bilateral asymmetries of the knee flexors. There were no significant differences observed between bowler’s and batter’s mean peak force and bilateral asymmetries. There were no significant differences between front and back limb mean peak force outputs. Discussion. Skill level, playing position and limb role appeared to have no significant effect on eccentric knee flexor strength and bilateral asymmetries. Future research should seek to determine whether eccentric knee flexor strength thresholds are predictive of HSIs in cricket and if specific eccentric knee flexor strengthening can reduce these injuries. PMID:26925310

  17. Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout.

    PubMed

    Hernández-Cortés, P; Caba, M; Gómez-Sánchez, R; Gómez-Morales, M

    2011-11-09

    The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis. Copyright 2011, SLACK Incorporated.

  18. Muscle-Pair Specific Distribution and Grip-Type Modulation of Neural Common Input to Extrinsic Digit Flexors

    PubMed Central

    Winges, Sara A.; Johnston, Jamie A.; Santello, Marco

    2007-01-01

    To gain insight into the synergistic control of hand muscles, we have recently quantified the strength of correlated neural activity across motor units from extrinsic digit flexors during a five-digit object-hold task. We found stronger synchrony and coherence across motor units from thumb and index finger flexor muscle compartment than between the thumb flexor and other finger flexor muscle compartments. The present study of two-digit object hold was designed to determine the extent to which such distribution of common input among thumb-finger flexor muscle compartments, revealed by holding an object with five digits, is preserved when varying the functional role of a given digit pair. We recorded normal force exerted by the digits and electrical activity of single motor units from muscle flexor pollicis longus (FPL) and two compartments of the m. flexor digitorum profundus (FDP2 and FDP3; index and middle finger, respectively). Consistent with our previous results from five-digit grasping, synchrony and coherence across motor units from FPL-FDP2 was significantly stronger than in FPL-FDP3 during object hold with two digits [common input strength: 0.49 ± 0.02 and 0.35 ± 0.02 (means ± SE), respectively; peak coherence: 0.0054 and 0.0038, respectively]. This suggests that the distribution of common neural input is muscle-pair specific regardless of grip type. However, the strength of coherence, but not synchrony, was significantly stronger in two- versus five-digit object hold for both muscle combinations, suggesting the periodicity of common input is sensitive to grip type. PMID:16723414

  19. Climbing-specific finger flexor performance and forearm muscle oxygenation in elite male and female sport climbers.

    PubMed

    Philippe, Marc; Wegst, Daniel; Müller, Tom; Raschner, Christian; Burtscher, Martin

    2012-08-01

    Climbing performance relies to a great extent on the performance of the finger flexor muscles. Only a few studies investigated this performance in top class climbers and only one study compared gender-specific differences. This study investigated the climbing-specific finger flexor strength and endurance and related muscular oxygenation in 12 elite female and male climbers and 12 non-climbers. After the assessment of maximum voluntary finger flexor contraction (MVC), two isometric finger flexor endurance tests were performed at 40% MVC until exhaustion. A continuous isometric test was followed by an intermittent isometric test (10 s contraction, 3 s rest). Changes in oxygenation of finger flexor muscles were recorded using near infrared spectroscopy. MVC and strength-to-weight ratio were greater in climbers than non-climbers (P = 0.003; P < 0.001) and greater in men than women (P < 0.001; P = 0.002). Time to task failure for the intermittent test and the force-time integrals for the continuous and the intermittent test were also significantly greater in climbers (P = 0.030; P = 0.027; P = 0.005). During the intermittent test, re-oxygenation of the working muscles was faster in climbers (P < 0.05) without gender-specific differences. Close correlations were demonstrated between the best on-sight climbing performance and strength-to-weight ratio (r (2) = 0.946, P < 0.001) only in female climbers. The superior intermittent finger flexor endurance of climbers over non-climbers may be explained by the faster re-oxygenation of the finger flexor muscles during the short rest phases.

  20. Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: a case-control study.

    PubMed

    Madeley, Luke T; Munteanu, Shannon E; Bonanno, Daniel R

    2007-12-01

    Medial tibial stress syndrome (MTSS) is a common overuse leg injury seen in athletes and can be recalcitrant to management. This cross-sectional study aimed to determine if there are differences in the isotonic endurance of the ankle joint plantar flexor muscles in athletes with MTSS compared to athletes without MTSS. The isotonic endurance of the ankle joint plantar flexors was measured in 30 participants diagnosed with MTSS, and 30 reference participants that were matched to MTSS participants on the basis of age (+/-5 years), gender, BMI (+/-5%) and type of sporting activity. The number of heel-rise repetitions of the participants in each group was compared for differences. There were no significant differences between participants with and without MTSS for age (p=0.34), height (p=0.40) or BMI (p=0.27). The mean number of heel-rise repetitions performed by participants in the MTSS group was significantly less than the reference group (mean 23, S.D. 5.6, versus mean 33, S.D. 8.6; p<0.001). These results suggest that athletes with MTSS have endurance deficits of the ankle joint plantar flexor muscles. Rehabilitation of athletes with MTSS should comprise training designed to enhance endurance of the lower limb musculature, including the ankle joint plantar flexors. It is not known whether a lack of endurance of the ankle joint plantar flexor muscles is the cause or effect of MTSS.

  1. Comparison of isometric force of the craniocervical flexor and extensor muscles between women with and without forward head posture.

    PubMed

    Bokaee, Fateme; Rezasoltani, Asghar; Manshadi, Farideh Dehghan; Naimi, Sedigheh Sadat; Baghban, Alireza Akbarzadeh; Azimi, Hadi

    2016-09-01

    The stability of the craniocervical (CC) area is provided by CC muscles. Muscle imbalance between forces of these muscles may lead to forward head posture (FHP). FHP is one of the most prevalent abnormal postures in patients with neck pain. The aim of the present study was to compare isometric force of the CC flexor and extensor muscles between women with and without FHP. Isometric force of the CC flexor and extensor muscles was measured by a custom-made device and compared between 70 women with and without FHP (35 in each group). No significant difference was observed between the two groups regarding isometric force of the CC flexor and extensor muscles, but the ratio of the isometric force of the CC muscles (flexor to extensor) revealed significant difference between the two groups, and it was greater in the control group compared with that in the FHP group. The ratio of isometric force of the CC muscles (flexor to extensor) may be a good indicator for assessment of patients with FHP. This ratio may also be valuable to follow the results of therapeutic intervention for these patients.

  2. Development of a kinematic model to predict finger flexor tendon and subsynovial connective tissue displacement in the carpal tunnel.

    PubMed

    Kociolek, Aaron M; Keir, Peter J

    2015-01-01

    Finger flexor tendinopathies and carpal tunnel syndrome are histologically characterised by non-inflammatory fibrosis of the subsynovial connective tissue (SSCT) in the carpal tunnel, which is indicative of excessive and repetitive shear forces between the finger flexor tendons and SSCT. We assessed flexor digitorum superficialis (FDS) tendon and adjacent SSCT displacements with colour Doppler ultrasound as 16 healthy participants completed long finger flexion/extension movements captured by a motion capture system. FDS tendon displacements fit a second-order regression model based on metacarpophalangeal and proximal interphalangeal joint flexion angles (R(2) = 0.92 ± 0.01). SSCT displacements were 33.6 ± 1.7% smaller than FDS tendon displacements and also fit a second-order regression model (R(2) = 0.89 ± 0.01). FDS tendon and SSCT displacement both correlated with finger joint thickness, enabling participant-specific anthropometric scaling. We propose the current regression models as an ergonomic method to determine relative displacements between the finger flexor tendons and SSCT. Relative displacements between the finger flexor tendons and SSCT provide insight into gliding and friction in the carpal tunnel. Our regression models represent a move towards mechanistic-based ergonomic risk assessment of the wrist/hand. This is a natural evolution of ergonomic methods based on tendon-joint interaction.

  3. Measurement of creep strain of flexor tendons during low-force high-frequency activities such as computer keyboard use.

    PubMed

    Smutz, W P; France, E P; Bloswick, D S

    1995-03-01

    The aim of this study was to measure tendon strain during low-force, high-frequency activities such as computer keyboard use. Prior to creep strain testing an estimate of flexor tendon force during keyboard use was made. Tendon force was measured indirectly by comparing electromyographic activity of the flexor and extensor digitorum muscles in five human volunteers for various hand activities. Results of the electromyographic study showed that flexor tendon forces during keyboard use may be as high as 60 N. Sixty eight flexor digitorum tendons from 17 fresh-frozen cadaver hands were used for the creep strain tests. Three loading conditions (static, 1 Hz cyclic, (1/4) Hz cyclic) and four load levels (10, 20, 50, 100 N) were used. Results of the creep study showed that for a flexor tendon force of 60 N the total strain of the tendon would be approximately 1.8%. This does not appear to be enough strain to cause permanent damage to the tendon according to current cumulative strain models. RELEVANCE: Recent studies have shown an increase in hand and wrist tendinitis among computer users. At the present time the aetiology is unknown, but risk factors commonly associated with tendinitis are hand forces, wrist postures, and frequency of finger movements. This research looks at tendon creep due to repeated force as a possible aetiology.

  4. [Isokinetic evaluation of the muscular strength and balance of knee extensor and flexor apparatus of taekwondo athletes].

    PubMed

    Martínez Hernández, Luis Enrique; Pegueros Pérez, Andrea; Ortiz Alvarado, Alfonso; Del Villar Morales, Ariadna; Flores, Víctor H; Pineda Villaseñor, Carlos

    2014-12-01

    Lower limb strength and muscular balance are important attributes in the practice of Taekwondo. To assess through isokinetic dynamometry the muscular strength and balance of knee extensor and flexor apparatus of elite Taekwondo athletes and to compare with recreational-type athletes. The maximum torque, the angle of maximum torque, maximum torque work, total work of the series, average power, and flexor and extensor muscle apparatus balance of the knees were obtained. A total of 32 knees were studied. Significantly higher values in peak torque and total work of the series were present in the group of TKD athletes in the extensor muscles, while the maximum torque angle of extensor and flexor muscles was higher in controls. We found a muscular imbalance due to flexor muscle strength deficit in both groups. Higher levels of muscular strength and an imbalance between the knee flexor and extensor muscle groups characterized the predominant motor gesture of TKD athletes. These results are useful in the design and implementation of training programs, to optimize the value of muscular strength and muscle balance in TKD athletes directed to promote optimal athletic performance and prevent sport-related injuries.

  5. Clinical and diagnostic imaging characteristics of lateral digital flexor tendinitis within the tarsal sheath in four horses.

    PubMed

    Davis, Weston; Caniglia, Christopher J; Lustgarten, Meghann; Blackwelder, Travis; Robertson, Ian; Redding, W Rich

    2014-01-01

    Lateral digital flexor tendonitis is a rarely reported cause of hind limb lameness in performance horses. The purpose of this retrospective study was to describe clinical and diagnostic imaging findings for a group of horses with lateral digital flexor tendinitis within the tarsal sheath. Equine cases with a diagnosis of lateral digital flexor tendonitis and magnetic resonance imaging (MRI) studies of the affected region were retrieved from North Carolina University’s medical record database. Recorded data for included horses were signalment; findings from history, physical examination, lameness examination, and all diagnostic imaging studies; treatment administered; and outcome. Four horses met inclusion criteria. Lameness was mild/moderate in severity and insidious in onset in all patients. Responses to flexion tests were variable. All horses showed positive improvement(70–90%) in lameness after tarsal sheath analgesia. Radiographic, scintigraphic, and ultrasonographic findings were inconclusive. For all horses, MRI characteristics included increased T2, PD, and STIR signal intensity within the lateral digital flexor tendon in the area of the tarsal sheath. Tarsal sheath effusion was slight in three horses, and mild/moderate in one horse. With medical treatment, two horses were sound at 6-month follow up, one horse was sound at 1-year followup, and one horse had a slight persistent lameness (grade 1/5) at 9-month followup. Findings supported the use of MRI for diagnosing lateral digital flexor tendonitis within the tarsal sheath in horses. Affected horses may have a good prognosis for return to athletic performance following appropriate medical treatment.

  6. High incidence and treatment of flexor carpi radialis tendinitis after trapeziectomy and abductor pollicis longus suspensionplasty for basal joint arthritis.

    PubMed

    Low, T H; Hales, P F

    2014-10-01

    We reviewed the incidence and treatment of flexor carpi radialis tendinitis in 77 patients (81 thumbs) who had trapeziectomy and abductor pollicis longus suspensionplasty for thumb carpometacarpal joint arthritis. Eighteen patients, 20 wrists (25%) had flexor carpi radialis tendinitis. The onset was 2-10 months (mean 4.7) after surgery. Two cases had preceding trauma. Eight cases (40%) responded to splinting and steroid injection. Ten patients, 12 wrists (60%) underwent surgery after failing non-operative treatment. Eleven wrists had frayed or partially torn flexor carpi radialis tendon and one had a complete tendon rupture with pseudotendon formation. Flexor carpi radialis tenotomy and pseudotendon excision were performed. All operated patients obtained good pain relief initially post-operatively. However, the pain recurred in two patients after 8 months. One required a local steroid injection for localized tenderness at the site of the proximal tendon stump. The other patient required a revision operation for scaphotrapezoid impingement. Both obtained complete pain relief. Our study has shown a high incidence of flexor carpi radialis tendinitis following trapeziectomy and abductor pollicis longus suspensionplasty. Patients should be warned about this potential complication. © The Author(s) 2013.

  7. Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training

    PubMed Central

    Behrens, Martin; Weippert, Matthias; Wassermann, Franziska; Bader, Rainer; Bruhn, Sven; Mau-Moeller, Anett

    2015-01-01

    Previously published studies on the effect of short-term endurance training on neuromuscular function of the plantar flexors have shown that the H-reflex elicited at rest and during weak voluntary contractions was increased following the training regime. However, these studies did not test H-reflex modulation during isometric maximum voluntary contraction (iMVC) and did not incorporate a control group in their study design to compare the results of the endurance training group to individuals without the endurance training stimulus. Therefore, this randomized controlled study was directed to investigate the neuromuscular function of the plantar flexors at rest and during iMVC before and after 8 weeks of cycling endurance training. Twenty-two young adults were randomly assigned to an intervention group and a control group. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque and muscle activation were measured. Triceps surae muscle activation and tibialis anterior muscle co-activation were assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0–100, 100–200 ms) and iMVC of the plantar flexors. Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during iMVC, V-wave), peak twitch torques induced by electrical stimulation of the posterior tibial nerve at rest and fatigue resistance were evaluated. The results indicate that cycling endurance training did not lead to a significant change in any variable of interest. Data of the present study conflict with the outcome of previously published studies that have found an increase in H-reflex excitability after endurance training. However, these studies had not included a control group in their study design as was the case here. It is concluded that short-term cycling endurance training does not necessarily enhance H-reflex responses and fatigue resistance. PMID:26029114

  8. Low-frequency force steadiness practice in plantar flexor muscle reduces postural sway during quiet standing.

    PubMed

    Oshita, Kazushige; Yano, Sumio

    2011-01-01

    The purpose of this study was to assess the effect of low-frequency force steadiness practice in the plantar flexor muscles on postural sway during quiet standing. Healthy young 21 men (21±1 yrs) were randomly assigned to a practice group (n=14) and a nonexercising control group (n=7). Practice groups were divided by frequency of practice: 7 participants practiced once a week, and the other 7 twice a week, for 4 weeks. Steadiness practice required practice group to 5 sets of 60-s contraction at levels corresponding to 10% and 20% maximal voluntary contraction (MVC) in the plantar flexor muscles. The 4-week-long practice period reduced the force fluctuations (assessed as the standard deviation (SD) of the outputted force during steady isometric plantar flexion) and postural sway (assessed as SD of the center of mass velocity during quiet standing). However, these practice effects were not significantly affected by the practice frequencies (1 vs. 2 sessions per week) examined in this study. Further, a linear regression analysis revealed the association between prepractice postural sway and the relative change in postural sway by the practice (r=-0.904) in the practice group. These results suggest that the steadiness practice in plantar flexor muscles improves postural stability during quiet standing, even though the practice is low-frequency (once a week) and low-intensity (within 20% MVC). These practice effects are dependent on prepractice postural stability. Further, the present results have provided the functional significance of force fluctuation in lower limb muscles.

  9. Flexor tenorrhaphy tensile strength: reduction by cyclic loading: in vitro and ex vivo porcine study.

    PubMed

    Gibbons, C E R; Thompson, D; Sandow, M J

    2009-06-01

    The integrity of the repair is critical to maintain coaptation of the severed flexor tendon end until healing has advanced sufficiently. In our hospital, we use a modified Savage repair (four-strand Adelaide technique) using 3-0 Ethibond (Ethicon, Somerville, NJ, USA) for acute flexor tenorrhaphy and an active postrepair mobilization protocol. To explain the apparent differences between the theoretical and actual repair strength of a multistrand repair in a single tension test and the reduced strength of a repair subjected to cyclic loading, we compared single and cyclical tensile loading with different suture in vitro configurations of 3-0 Ethibond (Ethicon, Somerville, NJ, USA; one, two, and four strands) and an ex vivo four-strand repair of freshly divided porcine tendon to calculate the ultimate tensile strength (UTS). Mechanical testing was repeated 15 times with both single tensile and cyclical loading for each suture configuration and porcine repair. In the in vitro model, the presence of a knot in a single strand reduced the UTS by 50%. The stiffness of a knotted strand was substantially less than the unknotted strand but became identical after cyclical loading. There was no statistical significance of the UTS between single and cyclical loading with different numbers of strands in this model. In the ex vivo four-strand porcine repair model, there was a significant reduction in UTS with cyclical loading, which equated to the number of strands times the strength of the knotted strand. This discrepancy can be explained by the change in stiffness of the knotted strand after cyclical loading and has important implications for previous studies of suture tendon repair using single tensile loading where the UTS may have been overestimated. We believe that cyclical loading is more representative of physiological loading after acute flexor tendon repair and should be the testing model of choice in suture tenorrhaphy studies.

  10. Strength deficit of knee flexors is dependent on hip position in adults with chronic hemiparesis.

    PubMed

    Michaelsen, Stella M; Ovando, Angélica C; Bortolotti, Adriano; Bandini, Bruno

    2013-01-01

    The extent to which muscle length affects force production in paretic lower limb muscles after stroke in comparison to controls has not been established. To investigate knee flexor strength deficits dependent on hip joint position in adults with hemiparesis and compare with healthy controls. a cross-sectional study with ten subjects with chronic (63±40 months) hemiparesis with mild to moderate lower limb paresis (Fugl-Meyer score 26±3) and 10 neurologically healthy controls. Isometric knee flexion strength with the hip positioned at 90° and 0° of flexion was assessed randomly on the paretic and non-paretic side of hemiparetic subjects and healthy controls. Subjects were asked to perform a maximal isometric contraction sustained for four seconds and measured by a dynamometer. The ratio of knee flexor strength between these two hip positions was calculated: Hip 0°/Hip 90°. Also, locomotor capacity was evaluated by the timed up and go test and by walking velocity over 10 meters. In subjects with hemiparesis, absolute knee flexion torque decreased (p<0.001) with the hip in extension (at 0°). The ratio of knee flexor torque Hip 0°/Hip 90° on the paretic side in hemiparetics was lower than in controls (p=0.02). Weakness dependent on joint position is more significant in the paretic lower limb of adults with hemiparesis when compared to controls. More attention should be given to lower limb muscle strengthening exercises in individuals with stroke, with emphasis on the strengthening exercises in positions in which the muscle is shortened.

  11. The use of a magnesium-based bone adhesive for flexor tendon-to-bone healing

    PubMed Central

    Stavros, Thomopoulos; Emmanouil, Zampiakis; Rosalina, Das; Hyun-Min, Kim; J., Silva, Matthew; Necat, Havlioglu; H., Gelberman, Richard

    2010-01-01

    Purpose Our previous studies in a canine animal model demonstrated that the flexor tendon-to-bone insertion site has a poor capacity to heal. Magnesium based adhesives have the potential to improve tendon-to-bone healing. Therefore, we hypothesized that magnesium based bone adhesive (MBA) will improve the tendon-to-bone biomechanical properties initially and in the early period after repair. Methods Flexor digitorum profundus tendons were injured and repaired into bone tunnels in the distal phalanges of dogs. The bone tunnels were either filled with MBA prior to completing the repair or left empty (CTL). Histologic appearance, tensile properties, range of motion, and bone density were examined at time zero and 21 days after the repair. Results There was no histologic evidence of acute inflammation. There appeared to be more mast cells in the MBA group than in the CTL group. Chronic inflammatory infiltrate and fibrosis was slightly higher in the MBA group compared to the CTL group. Tensile properties at time zero were significantly higher in the MBA group compared to the CTL group. However, tensile properties were significantly lower in the MBA group compared to the CTL group at 21 days. Range of motion and bone density were significantly lower in the MBA and CTL groups compared to normal (i.e., uninjured) at 21 days; no differences were seen when comparing MBA to CTL. Conclusions We found that the initial biomechanical properties of flexor tendon-to-bone repairs can be improved with MBA. However, MBA use in vivo led to a decrease in the biomechanical properties of the repair. There was no effect of MBA on bone density or range of motion in the early period after repair. Our histologic analysis suggests that the poor healing in the MBA group may have been due to an allergic response or to increased chronic inflammation due to the foreign material. PMID:19643291

  12. Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training.

    PubMed

    Behrens, Martin; Weippert, Matthias; Wassermann, Franziska; Bader, Rainer; Bruhn, Sven; Mau-Moeller, Anett

    2015-01-01

    Previously published studies on the effect of short-term endurance training on neuromuscular function of the plantar flexors have shown that the H-reflex elicited at rest and during weak voluntary contractions was increased following the training regime. However, these studies did not test H-reflex modulation during isometric maximum voluntary contraction (iMVC) and did not incorporate a control group in their study design to compare the results of the endurance training group to individuals without the endurance training stimulus. Therefore, this randomized controlled study was directed to investigate the neuromuscular function of the plantar flexors at rest and during iMVC before and after 8 weeks of cycling endurance training. Twenty-two young adults were randomly assigned to an intervention group and a control group. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque and muscle activation were measured. Triceps surae muscle activation and tibialis anterior muscle co-activation were assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0-100, 100-200 ms) and iMVC of the plantar flexors. Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during iMVC, V-wave), peak twitch torques induced by electrical stimulation of the posterior tibial nerve at rest and fatigue resistance were evaluated. The results indicate that cycling endurance training did not lead to a significant change in any variable of interest. Data of the present study conflict with the outcome of previously published studies that have found an increase in H-reflex excitability after endurance training. However, these studies had not included a control group in their study design as was the case here. It is concluded that short-term cycling endurance training does not necessarily enhance H-reflex responses and fatigue resistance.

  13. Terrible triad elbow fracture-dislocation with triceps and flexor-pronator mass avulsion.

    PubMed

    Gajendran, Varun K; Bishop, Julius A

    2015-02-01

    Terrible triad elbow injuries, consisting of fractures of the radial head and coronoid with ulnohumeral dislocation, are challenging to treat. They require a comprehensive understanding of the complex anatomy of the elbow to effectively treat all of the pathology and create a stable, congruent joint. The authors present a case of a terrible triad injury with avulsion of the triceps and flexor-pronator mass after a low-energy fall in a young patient. Although most terrible triad fracture-dislocations can be successfully treated with coronoid fixation, radial head fixation or replacement, and repair of the lateral collateral ligament complex, this case involved a completely circumferential injury to the elbow. The coronoid and anterior capsule were disrupted anteriorly, the radial head and lateral collateral ligament complex were disrupted laterally, the triceps was disrupted posteriorly, and the flexor-pronator mass was disrupted medially. Although the authors prefer to address most terrible triad injuries through a lateral approach, they suspected a circumferential injury preoperatively and elected to use a single posterior incision to address all of the pathology conveniently. This injury required treatment of all disrupted structures, because the elbow remained unstable until the triceps and flexor-pronator mass avulsions were ultimately repaired. With any elbow fracture-dislocation, surgeons should look for evidence of additional injuries that do not fit the commonly described patterns, because they may necessitate modifications to the treatment plan. Given the relatively common complications of stiffness and instability despite modern surgical techniques, additional injuries may further compromise functional outcomes unless they are addressed properly.

  14. Thumb and finger forces produced by motor units in the long flexor of the human thumb

    PubMed Central

    Yu, W S; Kilbreath, S L; Fitzpatrick, R C; Gandevia, S C

    2007-01-01

    The uncommonly good proprioceptive performance of the long flexor of the thumb, flexor pollicis longus (FPL), may add significantly to human manual dexterity. We investigated the forces produced by FPL single motor units during a weak static grip involving all digits by spike-triggered averaging from single motor units, and by averaging from twitches produced by intramuscular stimulation. Nine adult subjects were studied. The forces produced at each digit were used to assess how forces produced in FPL are distributed to the fingers. Most FPL motor units produced very low forces on the thumb and were positively correlated with the muscle force at recruitment. Activity in FPL motor units commonly loaded the index finger (42/55 units), but less commonly the other fingers (P < 0.001). On average, these motor units produced small but significant loading forces on the index finger (∼5.3% of their force on the thumb) with the same time-to-peak force as the thumb (∼50 ms), but had no significant effect on other fingers. However, intramuscular stimulation within FPL did not produce significant forces in any finger. Coherence at 2–10 Hz between the thumb and index finger force was twice that for the other finger forces and the coherence to the non-index fingers was not altered when the index finger did not participate in the grasp. These results indicate that, within the long-term coordinated forces of all digits during grasping, FPL motor units generate forces highly focused on the thumb with minimal peripheral transfer to the fingers and that there is a small but inflexible neural coupling to the flexors of the index finger. PMID:17656436

  15. Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs.

    PubMed

    Chauhan, Aakash; Schimoler, Patrick; Miller, Mark C; Kharlamov, Alexander; Merrell, Gregory A; Palmer, Bradley A

    2017-04-01

    The aim of the study was to compare biomechanical strength, repair times, and repair values for zone II core flexor tendon repairs. A total of 75 fresh-frozen human cadaveric flexor tendons were harvested from the index through small finger and randomized into one of 5 repair groups: 4-stranded cross-stitch cruciate (4-0 polyester and 4-0 braided suture), 4-stranded double Pennington (2-0 knotless barbed suture), 4-stranded Pennington (4-0 double-stranded braided suture), and 6-stranded modified Lim-Tsai (4-0 looped braided suture). Repairs were measured in situ and their repair times were measured. Tendons were linearly loaded to failure and multiple biomechanical values were measured. The repair value was calculated based on operating room costs, repair times, and suture costs. Analysis of variance (ANOVA) and Tukey post hoc statistical analysis were used to compare repair data. The braided cruciate was the strongest repair ( P > .05) but the slowest ( P > .05), and the 4-stranded Pennington using double-stranded suture was the fastest ( P > .05) to perform. The total repair value was the highest for braided cruciate ( P > .05) compared with all other repairs. Barbed suture did not outperform any repairs in any categories. The braided cruciate was the strongest of the tested flexor tendon repairs. The 2-mm gapping and maximum load to failure for this repair approached similar historical strength of other 6- and 8-stranded repairs. In this study, suture cost was negligible in the overall repair cost and should be not a determining factor in choosing a repair.

  16. Tenoscopic surgery for treatment of lacerations of the digital flexor tendon sheath.

    PubMed

    Fraser, B S L; Bladon, B M

    2004-09-01

    Lacerations to the digital flexor tendon sheath (DFTS) are a common injury in the horse, but little information is available in the literature regarding prognostic indicators. To ascertain whether laceration of the DFTS carried a better prognosis if treated by tenoscopic lavage, debridement and repair within 36 h of the original injury. A retrospective analysis of 39 horses treated surgically for lacerations to the DFTS was performed over a 3 year period. The injury-to-surgery interval was recorded as <36 or >36 h. The structures damaged by the injury were also recorded, as well as age, sex, use and outcome. Sixteen horses had laceration and contamination of the DFTS alone, of which 15 (94%) returned to their original or intended use. Sixteen horses had lacerations involving the superficial digital flexor tendon, of which 12 (75%) made a full recovery. Six horses had lacerations to both superficial and deep digital flexor tendons, 5 were subjected to euthanasia intraoperatively and one is paddock sound. Treatment within 36 h of initial laceration carried a significantly better prognosis for return to intended athletic use (25 of 28 horses allowed to recover from anaesthesia) than treatment after 36 h (2 of 5 P = 0.03; Fisher's Exact Test). If sepsis is treated early using tenoscopic visualisation, lavage and repositol antibiotics, the limiting factor in return to athletic function is tendon damage. This study supports anecdotal evidence that early treatment of synovial sepsis improves the prognosis for return to intended use. It also provides information on prognostic indicators including extent of damage to collateral structures.

  17. Flexor digitorum superficialis repair outside the A2 pulley after zone II laceration: gliding and bowstringing.

    PubMed

    Geary, Michael B; English, Christopher; Yaseen, Zaneb; Stanbury, Spencer; Awad, Hani; Elfar, John C

    2015-04-01

    To evaluate the changes in maximum flexion angle, gliding coefficient, and bowstringing after a combined repair of both flexor tendons with the flexor digitorum superficialis (FDS) rerouted outside the A2 pulley in cadaveric hands. We performed 4 different repairs on cadaveric hands, with each repair tested on 9 unique digits. In total, 12 cadaveric hands and 36 digits were used. The thumb and little finger were removed from each hand and excluded from testing. Group 1 was sham surgery. Group 2 combined flexor digitorum profundus (FDP) and FDS laceration and repair with both slips of the FDS repaired inside the A2 pulley. Group 3 was FDP repair with one slip of the FDS repaired inside A2 and the other slip left unrepaired. Group 4 was FDP repair with both slips of the FDS rerouted and repaired outside the A2 pulley. Maximum flexion angle, gliding coefficient, and bowstringing were measured in simulated active digital motion for each group. Rerouting and repairing the FDS outside the A2 pulley (group 4) significantly lowered gliding coefficient compared with repairs with both slips inside A2, with values similar to sham surgery. We observed no significant differences in maximum flexion angle among the 4 groups. Increased bowstringing was observed with both slips of the FDS repaired and rerouted outside the A2 pulley. In this cadaveric model, repair of both slips of the FDS outside the A2 pulley improved the gliding coefficient relative to repair within the A2 pulley, which suggests decreased resistance to finger flexion. Repair of the FDS outside the A2 pulley led to a slight increase in bowstringing of the FDS tendon. We describe a technique for managing combined laceration of the FDP and FDS tendons that improves gliding function and merits consideration. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. The spatial organization of central sensitization of hind limb flexor reflexes in the decerebrated, spinalized rabbit.

    PubMed

    Clarke, R W; Harris, J

    2001-01-01

    This study was designed to investigate the relationship between the location of a noxious stimulus and the magnitude and duration of the plastic effects induced by that stimulus in withdrawal reflexes acting about the knee and the ankle, in rabbits. Reflexes were evoked in the nerves to the anterior tibial and semitendinosus flexor muscles by electrical stimulation at the toes. Repetitive, high intensity electrical stimulation of nerve trunks (sural, medial gastrocnemius, superficial peroneal, tibial, 100 pulses, 20 V, 1 ms at 0.5 Hz) was generally found to be a poor method for inducing central sensitization in these flexor reflexes. 'Natural' noxious stimulation induced more reliable enhancement of both reflexes. Mechanical (clamp) or chemical (mustard oil) stimulation of the heel induced prolonged (median duration >30 min) increases in reflexes to both muscles. Mechanical (clamp and superficial pinch) or chemical (mustard oil) stimulation of the toes, and injection of bradykinin into the gastrocnemius muscles or into the soft tissues of the sole of the foot, also led to enhancement of both reflexes, with the median duration of potentiation between 7 and 30 min. The effects obtained from deep tissue stimulation were generally weaker than those obtained after stimulation of superficial structures. These data show that there were no major differences in the effects obtained from the heel vs the toes, or between the two reflexes. It appears that the spatial organization of the spinal mechanisms underlying central sensitization of flexor withdrawal reflexes is rather more crudely drawn than that pertaining to the reflexes themselves. Furthermore, the data indicate that in the present preparation, afferents from deep tissues are no more effective in generating central sensitization than those from superficial structures.

  19. Assessment of Muscle Pain Induced by Elbow-Flexor Eccentric Exercise.

    PubMed

    Lau, Wing Yin; Blazevich, Anthony J; Newton, Michael J; Wu, Sam Shi Xuan; Nosaka, Kazunori

    2015-11-01

    Delayed-onset muscle soreness (DOMS) is a common muscle pain that many people experience and is often used as a model of acute muscle pain. Researchers have reported the effects of various interventions on DOMS, but different DOMS assessment protocols used in these studies make it difficult to compare the effects. To investigate DOMS characteristics after elbow-flexor eccentric exercise to establish a standardized DOMS assessment protocol. Descriptive laboratory study. Research laboratory. Ten healthy, untrained men (21-39 years). Participants performed 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors. Indirect muscle-damage markers were maximal voluntary isometric contraction torque, range of motion, and serum creatine kinase activity. Muscle pain was assessed before exercise, immediately postexercise, and 1 to 5 days postexercise using (1) a visual analog scale (VAS), (2) a category ratio-10 scale (CR-10) when applying static pressure and palpation at different sites (3, 9, and 15 cm above the elbow crease), and (3) pressure-pain thresholds (PPTs) at 50 sites (pain mapping). Maximal voluntary isometric contraction and range of motion decreased and creatine kinase activity increased postexercise, indicating muscle damage. Palpation induced greater pain than static pressure, and longitudinal and transverse palpations induced greater pain than circular palpation (P < .05). The PPT was lower in the medial region before exercise, but the pain-sensitive regions shifted to the central and distal regions of the biceps brachii at 1 to 3 days postexercise (P < .05). The VAS was correlated with the CR-10 scale (r = 0.91, P < .05) but not with the PPT (r = -0.28, P = .45). The way in which muscles are assessed affects the pain level score. This finding suggests that pain level and pain threshold cannot be used interchangeably and that the central and distal regions of the biceps brachii should be included in DOMS assessment using the VAS, CR-10

  20. Flexor pollicis brevis adductorplasty: an alternative method in ulnar nerve paralysis.

    PubMed

    Uraloğlu, Muhammet; Orbay, Hakan; Açar, Halil Ibrahim; Sensöz, Omer

    2006-07-01

    Loss of pinch power associated with loss of coordinated movement of thumb and index fingers is the major disability in patients with ulnar nerve paralysis. Several tendon transfer methods utilizing different donor muscles have been used to restore adductor pollicis muscle function in ulnar nerve paralysis. In this paper, we discuss the transfer of flexor digitorum brevis muscle to the tendon of adductor pollicis muscle as an alternative method to restore key pinch in ulnar nerve paralysis. The technique was applied to 4 patients with ulnar nerve paralysis. Before clinical application, an anatomic study was carried out in 6 cadaver hands. In cadavers, radial and ulnar arteries were injected with latex and arterial pedicles of flexor pollicis brevis muscle were dissected under 4x magnification. Also, motor branches from the median nerve were shown at the entrance point to the muscle. In surgical practice, the superficial head of the muscle is detached from its insertion and the minor pedicle of the muscle is cut. Muscle is dissected proximally up to two thirds of its length. The dominant pedicle of the muscle originating from superficial palmar arcus is preserved, and the muscle is sutured to the tendon of the adductor pollicis muscle close to its insertion. Patients were evaluated in terms of key pinch strength preoperatively and at the postoperative sixth month using a pinch meter (Chattanooga Group, Inc). Key pinch strengths were recorded and expressed as percentage of the strength of the contralateral uninvolved hand. Mean key pinch strength of our patients was 29.7%. In conclusion, we believe in that flexor pollicis brevis adductorplasty may be an alternative method for restoration of adductor pollicis muscle function in ulnar nerve paralysis.

  1. Tendon-derived progenitor cells improve healing of collagenase-induced flexor tendinitis.

    PubMed

    Durgam, Sushmitha S; Stewart, Allison A; Sivaguru, Mayandi; Wagoner Johnson, Amy J; Stewart, Matthew C

    2016-12-01

    Tendinitis is a common and a performance-limiting injury in athletes. This study describes the value of intralesional tendon-derived progenitor cell (TDPC) injections in equine flexor tendinitis. Collagenase-induced tendinitis was created in both front superficial digital flexor (SDF) tendons. Four weeks later, the forelimb tendon lesions were treated with 1 × 10(7) autogenous TDPCs or saline. Tendinitis was also induced by collagenase in one hind SDF tendon, to study the survival and distribution of DiI-labeled TDPCs 1, 2, 4, and 6 weeks after injection. The remaining normal tendon was used as a "control." Twelve weeks after forelimb TDPC injections, tendons were harvested for assessment of matrix gene expression, biochemical, biomechanical, and histological characteristics. DiI-labeled TDPCs were abundant 1 week after injection but gradually declined over time and were undetectable after 6 weeks. Twelve weeks after TDPC injection, collagens I and III, COMP and tenomodulin mRNA levels were similar (p = 0.3) in both TDPC and saline groups and higher (p < 0.05) than normal tendon. Yield and maximal stresses of the TDPC group were significantly greater (p = 0.005) than the saline group's and similar (p = 0.6) to normal tendon. However, the elastic modulus of the TDPC and saline groups were not significantly different (p = 0.32). Histological assessment of the repair tissues with Fourier transform-second harmonic generation imaging demonstrated that collagen alignment was significantly better (p = 0.02) in TDPC group than in the saline controls. In summary, treating collagenase-induced flexor tendon lesions with TDPCs improved the tensile strength and collagen fiber alignment of the repair tissue. Study Design © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2162-2171, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  2. Characteristics of acute groin injuries in the hip flexor muscles - a detailed MRI study in athletes.

    PubMed

    Serner, A; Weir, A; Tol, J L; Thorborg, K; Roemer, F; Guermazi, A; Yamashiro, E; Hölmich, P

    2017-06-26

    Hip flexor injuries account for one-third of acute groin injuries; however, little is known about specific injury characteristics. The aims of this study were to describe acute hip flexor injuries using magnetic resonance imaging (MRI) in athletes with acute groin pain and to compare specific muscle injuries with reported injury situations. Male athletes with acute groin pain were prospectively and consecutively included during three sports seasons. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. All athletes with an MRI confirmed acute hip flexor muscle injury were included. A total of 156 athletes presented with acute groin pain of which 33 athletes were included, median age 26 years (range 18-35). There were 16 rectus femoris, 12 iliacus, 7 psoas major, 4 sartorius, and 1 tensor fascia latae injury. Rectus femoris injuries primarily occurred during kicking (10) and sprinting (4), whereas iliacus injuries most frequently occurred during change of direction (5). In 10 (63%) rectus femoris injuries, tendinous injury was observed. The iliacus and psoas major injuries were mainly observed at the musculotendinous junction (MTJ), and two included tendinous injury. We have illustrated specific injury locations within these muscles, which may be relevant for the clinical diagnosis and prognosis of these injuries. Most proximal rectus femoris injuries included tendinous injury. In contrast, distinct acute iliacus and psoas injuries predominantly occurred at the MTJ. Only the iliacus or psoas major were injured during change of direction, whereas rectus femoris injuries occurred primarily during kicking and sprinting. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Development of a synthetic replacement for flexor tendon pulleys using expanded polytetrafluoroethylene membrane.

    PubMed

    Bartle, B K; Telepun, G M; Goldberg, N H

    1992-03-01

    Reconstruction or replacement of the damaged pulley is a difficult surgical problem because of the need to find suitable biological material, the bulkiness of the repair, and adhesion formation between the pulley and flexor tendons. Therefore, a method was developed to reconstruct the fibro-osseous pulleys with polytetrafluoroethylene (PTFE) membrane. Twenty White Leghorn chickens had the A3 pulley of the long digit excised; this was followed by a standard injury to the flexor profundus tendon. The A3 pulley was then reconstructed with PTFE membrane. In the opposite foot, the A3 pulley was transected laterally, the tendon injured in the same manner, and the native pulley sutured. Seven control chickens had a PTFE pulley reconstruction without tendon injury in one foot and the opposite foot did not undergo surgery. At postoperative days 0, 21, and 35, the animals were killed to evaluate the effectiveness of the PTFE pulleys. Flexor tendon function was assessed by determining the active range of motion of the digit. There was no significant difference between the PTFE pulleys and suture repair of the native pulleys at postoperative days 21 and 35. This indicates that the PTFE pulleys were capable of preventing tendon bow-stringing and did not significantly impair tendon gliding. The breaking strength of the PTFE pulley was less than that of the normal A3 pulleys, but it was sufficient to allow immediate mobilization of the digits postoperatively without fear of pulley rupture. The synthetic PTFE pulley appears to have the potential to function as an effective immediate replacement for the fibro-osseous pulleys.

  4. Shaping the Output of Lumbar Flexor Motoneurons by Sacral Neuronal Networks.

    PubMed

    Cherniak, Meir; Anglister, Lili; Lev-Tov, Aharon

    2017-02-01

    The ability to improve motor function in spinal cord injury patients by reactivating spinal central pattern generators (CPGs) requires the elucidation of neurons and pathways involved in activation and modulation of spinal networks in accessible experimental models. Previously we reported on adrenoceptor-dependent sacral control of lumbar flexor motoneuron firing in newborn rats. The current work focuses on clarification of the circuitry and connectivity involved in this unique modulation and its potential use. Using surgical manipulations of the spinal gray and white matter, electrophysiological recordings, and confocal microscopy mapping, we found that methoxamine (METH) activation of sacral networks within the ventral aspect of S2 segments was sufficient to produce alternating rhythmic bursting (0.15-1 Hz) in lumbar flexor motoneurons. This lumbar rhythm depended on continuity of the ventral funiculus (VF) along the S2-L2 segments. Interrupting the VF abolished the rhythm and replaced it by slow unstable bursting. Calcium imaging of S1-S2 neurons, back-labeled via the VF, revealed that ∼40% responded to METH, mostly by rhythmic firing. All uncrossed projecting METH responders and ∼70% of crossed projecting METH responders fired with the concurrent ipsilateral motor output, while the rest (∼30%) fired with the contralateral motor output. We suggest that METH-activated sacral CPGs excite ventral clusters of sacral VF neurons to deliver the ascending drive required for direct rhythmic activation of lumbar flexor motoneurons. The capacity of noradrenergic-activated sacral CPGs to modulate the activity of lumbar networks via sacral VF neurons provides a novel way to recruit rostral lumbar motoneurons and modulate the output required to execute various motor behaviors.

  5. Excitatory neurotransmitters in the tentacle flexor muscles responsible for space positioning of the snail olfactory organ.

    PubMed

    Krajcs, N; Hernádi, L; Elekes, K; Kimura, S; Kiss, T

    2014-03-01

    Recently, three novel flexor muscles (M1, M2 and M3) in the posterior tentacles of the snail have been described, which are responsible for the patterned movements of the tentacles of the snail, Helix pomatia. In this study, we have demonstrated that the muscles received a complex innervation pattern via the peritentacular and olfactory nerves originating from different clusters of motoneurons of the cerebral ganglia. The innervating axons displayed a number of varicosities and established neuromuscular contacts of different ultrastructural forms. Contractions evoked by nerve stimulation could be mimicked by external acetylcholine (ACh) and glutamate (Glu), suggesting that ACh and Glu are excitatory transmitters at the neuromuscular contacts. Choline acetyltransferase and vesicular glutamate transporter immunolabeled axons innervating flexor muscles were demonstrated by immunohistochemistry and in Western blot experiments. Nerve- and transmitter-evoked contractions were similarly attenuated by cholinergic and glutamatergic antagonists supporting the dual excitatory innervation. Dopamine (DA, 10⁻⁵ M) oppositely modulated thin (M1/M2) and thick (M3) muscle responses evoked by stimulation of the olfactory nerve, decreasing the contractions of the M1/M2 and increasing those of M3. In both cases, the modulation site was presynaptic. Serotonin (5-HT) at high concentration (10⁻⁵ M) increased the amplitude of both the nerve- and the ACh-evoked contractions in all muscles. The relaxation rate was facilitated suggesting pre- and postsynaptic site of action. Our data provided evidence for a DAergic and 5-HTergic modulation of cholinergic nerves innervating flexor muscles of the tentacles as well as the muscles itself. These effects of DA and 5-HT may contribute to the regulation of sophisticated movements of tentacle muscles lacking inhibitory innervation.

  6. Effects of Acute Fatigue of the Hip Flexor Muscles on Hamstring Muscle Extensibility

    PubMed Central

    Arrabal-Campos, Francisco M.

    2016-01-01

    Abstract The purpose of the present study was to evaluate the influence of acute fatigue of the hip flexor muscles on scores attained in tests frequently used in literature to measure hamstring muscle extensibility, namely the passive straight leg raise (PSLR), active straight leg raise (ASLR), passive knee extension (PKE), active knee extension (AKE), sit-and-reach (SR) and toe-touch (TT) tests. A total of seventy-five healthy and recreationally active adults voluntarily participated in this study. To reach fatigue, the participants actively lifted their legs alternately as many times as possible. In the passive tests, the results were 7.10 ± 5.21° and 5.68 ± 4.54° higher (p < 0.01) for PSLR and PKE tests, respectively, after acute fatigue. However, in the ASLR test, the results were lower post-fatigue than pre-fatigue (mean difference = -5.30° ± 9.51°; p < 0.01). The AKE, SR and TT tests did not show significant differences between pre- and post-fatigue (p > 0.05). Moderate (r = 0.40) to high (r = 0.97) correlation coefficients were found, which were statistically significant among all the measured flexibility tests both pre- and post-fatigue. In conclusion, the active implication of the hip flexor muscles until reaching fatigue had acute influences on the results of the PSLR, PKE and ASLR tests, but not on the results of the AKE, SR and TT tests. It is recommended to use the AKE test to assess hamstring muscle extensibility in situations where athletes show fatigue in their hip flexor muscles. PMID:28149407

  7. Digital Necrosis After Lidocaine and Epinephrine Injection in the Flexor Tendon Sheath Without Phentolamine Rescue.

    PubMed

    Zhang, Jacques X; Gray, Jason; Lalonde, Donald H; Carr, Nicholas

    2017-02-01

    The literature generally supports the safety of epinephrine injection in the digits, but recent case reports describe ischemic adverse events associated with the use of lidocaine and epinephrine in which phentolamine rescue was not performed. We present a case of finger necrosis and subsequent amputation in a patient after 1% lidocaine with 1:100,000 epinephrine was injected in the fat and flexor sheaths in the palm for a 3-finger trigger release. Phentolamine rescue was not performed. All surgeons who use epinephrine in the finger should be prepared to reverse vasoconstriction with phentolamine rescue if there is persistently inadequate perfusion of the fingertip.

  8. Palmaris longus muscle substituting for the ring finger slip of flexor digitorum superficialis.

    PubMed

    Cassell, M D; Bergman, R A

    1990-01-01

    An unusual and unrecorded variation in palmaris longus muscle is described. The muscle had a normal appearance and origin from the common tendon arising from the medial epicondyle of the humerus and from the surrounding intermuscular septa. The distal tendon however entered the hand via the carpal tunnel medial and deep to the median nerve, split and inserted into the lateral and medial sides of the middle phalanx of the ring finger. It therefore substituted completely for the slip to the ring finger from flexor digitorum superficials, which was absent.

  9. Estimation of heritability for superficial digital flexor tendon injury by Gibbs sampling in the Thoroughbred racehorse.

    PubMed

    Oki, H; Miyake, T; Kasashima, Y; Sasaki, Y

    2008-12-01

    The superficial digital flexor tendon (SDFT) injury causes considerable wastage of racing Thoroughbreds. In this study, the heritability of SDFT injury of the forelimbs was estimated in the Thoroughbred racehorses based on the Bayesian analysis with Gibbs sampling using threshold animal models. New horse patients of SDFT injury at the age of 2-5 years accommodated in the training centers in 2005 were used for the analyses. Based on clinical data of 8198 horses, heritability of SDFT was estimated to be the order of 0.17 (posterior mode) to 0.19 +/- 0.05 (posterior mean +/- posterior SD).

  10. Novel triplet of flexor muscles in the posterior tentacles of the snail, Helix pomatia.

    PubMed

    Hernádi, L; Teyke, T

    2012-01-01

    The anatomy of three novel flexor muscles in the posterior tentacles of Helix pomatia is described. The muscles originate from the ventral side of the sensory pad and are anchored at different sites in the base of the tentacle stem. The muscles span the tentacle and always take the length of the stem which depends on the rate of tentacle protrusion indicating that the muscles are both contractile and extremely stretchable. The three anchoring points at the base of the stem determine three space axes along which the contraction of a muscle or the synchronous contraction of the muscles can move the tentacle in space.

  11. Acute calcific tendinitis of the flexor pollicis longus in an 8-year-old boy.

    PubMed

    Kheterpal, Arvin; Zoga, Adam; McClure, Kristen

    2014-10-01

    Calcific tendinitis is a common source of musculoskeletal pain in adults; however, it is rarely encountered in children. Calcific tendinitis is the most commonly encountered manifestation of hydroxyapatite deposition disease, in which calcium hydroxyapatite crystal deposition occurs in tendons. It may cause acute or chronic pain, or may be entirely asymptomatic. We describe a case of acute calcific tendinitis of the flexor pollicis longus tendon in an 8-year-old boy, who initially presented to our department for workup of a mass felt along the volar aspect of the right wrist.

  12. Tissue engineering in flexor tendon surgery: current state and future advances.

    PubMed

    Galvez, M G; Crowe, C; Farnebo, S; Chang, J

    2014-01-01

    Tissue engineering of flexor tendons addresses a challenge often faced by hand surgeons: the restoration of function and improvement of healing with a limited supply of donor tendons. Creating an engineered tendon construct is dependent upon understanding the normal healing mechanisms of the tendon and tendon sheath. The production of a tendon construct includes: creating a three-dimensional scaffold; seeding cells within the scaffold; encouraging cellular growth within the scaffold while maintaining a gliding surface; and finally ensuring mechanical strength. An effective construct incorporates these factors in its design, with the ultimate goal of creating tendon substitutes that are readily available to the reconstructive hand surgeon.

  13. Injuries to the finger flexor pulley system in rock climbers: current concepts.

    PubMed

    Schöffl, Volker Rainer; Schöffl, Isabelle

    2006-04-01

    Closed traumatic ruptures of finger flexor tendon pulleys began to be recognized specifically over the past several decades. This injury, although rare in the general population, is seen more commonly in rock climbers. This article analyzes this type of injury and the current diagnostic and therapeutic criteria. Ultrasound and magnetic resonance imaging are used to differentiate between a pulley strain, partial rupture, complete rupture, or multiple ruptures. Grade I to III injuries (strains, partial rupture, single ruptures) are treated conservatively with initial immobilization and early functional therapy under pulley protection. Grade IV injuries (multiple ruptures) require surgical repair.

  14. A Case of Congenital Bilateral Absence of Elbow Flexor Muscles: Review of Differential Diagnosis and Treatment

    PubMed Central

    Aliu, Oluseyi; Samra, Saleh; Lewis, Eric

    2007-01-01

    A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient’s treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma. PMID:18780113

  15. MyDas, an extensible Java DAS server.

    PubMed

    Salazar, Gustavo A; García, Leyla J; Jones, Philip; Jimenez, Rafael C; Quinn, Antony F; Jenkinson, Andrew M; Mulder, Nicola; Martin, Maria; Hunter, Sarah; Hermjakob, Henning

    2012-01-01

    A large number of diverse, complex, and distributed data resources are currently available in the Bioinformatics domain. The pace of discovery and the diversity of information means that centralised reference databases like UniProt and Ensembl cannot integrate all potentially relevant information sources. From a user perspective however, centralised access to all relevant information concerning a specific query is essential. The Distributed Annotation System (DAS) defines a communication protocol to exchange annotations on genomic and protein sequences; this standardisation enables clients to retrieve data from a myriad of sources, thus offering centralised access to end-users.We introduce MyDas, a web server that facilitates the publishing of biological annotations according to the DAS specification. It deals with the common functionality requirements of making data available, while also providing an extension mechanism in order to implement the specifics of data store interaction. MyDas allows the user to define where the required information is located along with its structure, and is then responsible for the communication protocol details.

  16. Immediate effects of forearm elastic and nonelastic taping on wrist flexor muscle and grip strength of normal adults

    PubMed Central

    Cha, Hyun-Gyu; Kim, Myoung-Kwon; Shin, Young-Jun

    2016-01-01

    [Purpose] The purpose of this study was to examine the effects of forearm elastic taping on grip and wrist flexor muscle strength. [Subjects and Methods] This was a single-blind, crossover study. This study selected 40 healthy subjects with no history of orthopedic disorders and was conducted after consent to participate was obtained. Grip and wrist flexor muscle strength of subjects were assessed by a handheld dynamometer and a Commander Muscle Tester, respectively, with forearm elastic taping or nonelastic taping. [Results] After application of forearm elastic taping, grip strength and wrist flexor muscle strength significantly increased compared with the nonelastic taping group. [Conclusion] Application of forearm elastic taping is considered to have positive effects on improving wrist and grip strength. PMID:27821932

  17. Correlation of single-breath count test and neck flexor muscle strength with spirometry in myasthenia gravis

    PubMed Central

    Elsheikh, Bakri; Arnold, W. David; Gharibshahi, Shahram; Reynolds, Jerold; Freimer, Miriam; Kissel, John T.

    2015-01-01

    Introduction Although formal spirometry is the gold standard for monitoring respiratory function in patients with myasthenia gravis (MG), such testing is often delayed or unavailable. There is a need for a simple bedside test that can accurately measure respiratory function. Method We conducted a prospective, cross-sectional, single-blind study in adults with acetylcholine receptor antibody positive MG. Participants performed the single breath count test (SBCT) and underwent manual muscle strength testing, while a respiratory therapist performed spirometry blinded to SBCT and strength results. Results Thirty-one patients, aged 57 ±19 years participated. SBCT showed significant correlations with forced vital capacity (FVC), negative inspiratory force (NIF), and neck flexor strength (P<0.01). FVC showed significant correlation with neck flexor strength (P=0.02) but no correlation with shoulder abductor strength. Discussion These data suggest that the SBCT and neck flexor strength testing are valuable tools for bedside assessment of respiratory function in MG patients. PMID:26437790

  18. Accuracy of open magnetic resonance imaging for guiding injection of the equine deep digital flexor tendon within the hoof.

    PubMed

    Groom, Lauren M; White, Nathaniel A; Adams, M Norris; Barrett, Jennifer G

    2017-07-06

    Lesions of the distal deep digital flexor tendon (DDFT) are frequently diagnosed using MRI in horses with foot pain. Intralesional injection of biologic therapeutics shows promise in tendon healing; however, accurate injection of distal deep digital flexor tendon lesions within the hoof is difficult. The aim of this experimental study was to evaluate accuracy of a technique for injection of the deep digital flexor tendon within the hoof using MRI-guidance, which could be performed in standing patients. We hypothesized that injection of the distal deep digital flexor tendon within the hoof could be accurately guided using open low-field MRI to target either the lateral or medial lobe at a specific location. Ten cadaver limbs were positioned in an open, low-field MRI unit. Each distal deep digital flexor tendon lobe was assigned to have a proximal (adjacent to the proximal aspect of the navicular bursa) or distal (adjacent to the navicular bone) injection. A titanium needle was inserted into each tendon lobe, guided by T1-weighted transverse images acquired simultaneously during injection. Colored dye was injected as a marker and postinjection MRI and gross sections were assessed. The success of injection as evaluated on gross section was 85% (70% proximal, 100% distal). The success of injection as evaluated by MRI was 65% (60% proximal, 70% distal). There was no significant difference between the success of injecting the medial versus lateral lobe. The major limitation of this study was the use of cadaver limbs with normal tendons. The authors conclude that injection of the distal deep digital flexor tendon within the hoof is possible using MRI guidance. © 2017 American College of Veterinary Radiology.

  19. The influence of soccer-specific fatigue on peak isokinetic torque production of the knee flexors and extensors.

    PubMed

    Greig, Matt

    2008-07-01

    Epidemiological findings of higher muscular thigh strain injury incidence during the latter stages of soccer match play have been attributed to fatigue. Soccer-specific fatigue will significantly reduce peak isokinetic torque of the knee flexors and extensors. Descriptive laboratory study. Ten male professional soccer players (mean age, 24.7 +/- 4.4 years; body mass, 77.1 +/- 8.3 kg; maximum oxygen consumption [VO(2) max], 63.0 +/- 4.8 mL/kg/min) completed an intermittent treadmill protocol replicating the activity profile of match play. Before exercise and at 15-minute intervals, each player completed 1 of 2 randomized isokinetic dynamometer protocols. The first protocol quantified peak concentric knee extensor and flexor torque, while the second quantified peak concentric and eccentric knee flexor torque at isokinetic speeds of 180, 300, and 60 deg/s (3.14, 5.25, and 1.05 rad/s) with 5 repetitions at each speed. Concentric knee extensor and flexor peak torque were maintained throughout the duration of the exercise protocol, irrespective of movement speed. However, peak eccentric knee flexor torques at the end of the game (T(300eccH105) = 127 +/- 25 N.m) and at the end of the passive half-time interval (T(300eccH60) = 133 +/- 32 N.m) were significantly reduced relative to the first 15 minutes (T(300eccH00) = 167 +/- 35 N.m, P < .01; T(300eccH15) = 161 +/- 35 N.m, P = .02). Eccentric knee flexor strength decreases as a function of time and after the half-time interval. This suggests a greater risk of injuries at these specific times, especially for explosive movements, in accord with epidemiological observations.

  20. Impaired Foot Plantar Flexor Muscle Performance in Individuals With Plantar Heel Pain and Association With Foot Orthosis Use.

    PubMed

    McClinton, Shane; Collazo, Christopher; Vincent, Ebonie; Vardaxis, Vassilios

    2016-08-01

    Study Design Controlled laboratory study. Background Plantar heel pain is one of the most common foot and ankle conditions seen in clinical practice, and many individuals continue to have persisting or recurrent pain after treatment. Impaired foot plantar flexor muscle performance is a factor that may contribute to limited treatment success, but reliable methods to identify impairments in individuals with plantar heel pain are needed. In addition, foot orthoses are commonly used to treat this condition, but the implications of orthosis use on muscle performance have not been assessed. Objectives To assess ankle plantar flexor and toe flexor muscle performance in individuals with plantar heel pain using clinically feasible measures and to examine the relationship between muscle performance and duration of foot orthosis use. Methods The rocker-board plantar flexion test (RBPFT) and modified paper grip test for the great toe (mPGTGT) and lesser toes (mPGTLT) were used to assess foot plantar flexor muscle performance in 27 individuals with plantar heel pain and compared to 27 individuals without foot pain who were matched according to age, sex, and body mass. Pain ratings were obtained before and during testing, and self-reported duration of foot orthosis use was recorded. Results Compared to the control group, individuals with plantar heel pain demonstrated lower performance on the RBPFT (P = .001), the mPGTGT (P = .022), and the mPGTLT (P = .037). Longer duration of foot orthosis use was moderately correlated to lower performance on the RBPFT (r = -0.52, P = .02), the mPGTGT (r = -0.54, P = .01), and the mPGTLT (r = -0.43, P = .03). Conclusion Ankle plantar flexor and toe flexor muscle performance was impaired in individuals with plantar heel pain and associated with longer duration of self-reported foot orthosis use. J Orthop Sports Phys Ther 2016;46(8):681-688. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6482.

  1. Sonographic appearance of the flexor tendon, volar plate, and A1 pulley with respect to the severity of trigger finger.

    PubMed

    Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro

    2012-10-01

    To evaluate trigger digits with sonography to determine morphological changes in the A1 pulley, flexor tendon, and volar plate in relation to the severity of triggering. We evaluated 67 trigger digits and graded them into 1 of 4 groups. We compared the groups according to severity and to contralateral fingers, which served as controls. The thickness of the flexor tendons under the A1 pulley was proportional to the severity of triggering. The anteroposterior thickness of the flexor tendon increased significantly among the grades exhibiting triggering regardless of the affected digit. However, in digits other than the thumb, tendon thickness increased even in the absence of active triggering. Thickening tended to be greater with finger flexion. The A1 pulley exhibited the greatest thickness and the volar plate exhibited significant thickening in the group that exhibited continuous triggering that was easily reduced with active extension (grade III). The flexor tendon thickened significantly before patients experienced triggering except in the thumb. In the thumb, the flexor tendon and A1 pulley thickened significantly only after patients exhibited triggering. Thickening of the volar plate appears to have an important role in continuous triggering. Although most clinicians can easily determine the severity of a trigger digit by clinical examination, ultrasound might be helpful for objectively understanding the severity and response to treatment, by examining the thickness of the flexor tendon and A1 pulley. In particular, sonographic measurement of the A1 pulley might be useful in judging the progression of trigger finger severity. In cases where a Doppler signal is detected inside the A1 pulley, more conservative therapies might be worth considering before surgery. Diagnostic ΙΙΙ. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  2. The effects of centrally acting muscle relaxants on the intrathecal noradrenaline-induced facilitation of the flexor reflex mediated by group II afferent fibers in rats.

    PubMed

    Sakitama, K

    1993-11-01

    The effects of centrally acting muscle relaxants on the flexor reflex mediated by group II afferent fibers (group II flexor reflex) in anesthetized intact rats and on the intrathecal noradrenaline-HCl-induced facilitation of the group II flexor reflex in anesthetized spinal rats were investigated. In anesthetized intact rats, mephenesin, tolperisone-HCl, chlorpromazine-HCl and baclofen inhibited the group II flexor reflex dose-dependently, whereas the inhibitory effect of tizanidine-HCl was bell-shaped. The effect of diazepam tended to be saturated. In anesthetized spinal rats, mephenesin, tolperisone-HCl, chlorpromazine-HCl, diazepam and baclofen also depressed the group II flexor reflex, but tizanidine-HCl slightly increased it. The intrathecal noradrenaline-HCl-induced facilitation of the group II flexor reflex was not affected by mephenesin or diazepam, but was inhibited by tizanidine-HCl, tolperisone-HCl, chlorpromazine-HCl and baclofen. These results suggest that compounds with centrally acting muscle relaxant activity depress the group II flexor reflex in different manners, and the inhibition of descending noradrenergic tonic facilitation within the spinal cord participates in the depressant action of the group II flexor reflex produced by tolperisone-HCl, tizanidine-HCl, chlorpromazine-HCl and baclofen.

  3. Measurement of ankle plantar flexor spasticity following stroke: Assessment of a new quantitative tool.

    PubMed

    Chino, Naoichi; Muraoka, Yoshihiro; Ishihama, Hiroki; Ide, Masaru; Ushijima, Riousuke; Basford, Jeffrey R

    2015-09-01

    To assess the ability of a newly developed portable instrument (the Electric Spastic Ankle Measure (E-SAM)) to quantitatively measure ankle plantar flexor muscle tone and spasticity. Comparison of quantitative measurements of the E-SAM with those obtained manually with the Modified Ashworth Scale (MAS). Seven adult men with stroke of more than 8 months' duration with a MAS score of 3, and 7 healthy age-matched control subjects. Quantitative measurements of the reactive and viscoelastic components of muscle tonus and spasticity. Analysis of the pooled data of all subjects revealed 2 components: an initial negative peak (indicating visco-elasticity), and subsequent positive peaks (denoting reactive contractions of the plantar flexor muscles). Positive, reactive contraction, peaks of the subjects with stroke were significantly higher than those of age-matched controls (p<0.01, t-test). The E-SAM appears to provide meaningful information on muscle tone and spasticity that is more specific and quantitative than that obtained with the MAS. While further study is necessary, this instrument shows promise as an easy-to-use clinical and research tool for the measurement of spasticity and muscle viscosity.

  4. Rehabilitation outcomes in patients with early and two-stage reconstruction of flexor tendon injuries

    PubMed Central

    Sade, Ilgin; İnanir, Murat; Şen, Suzan; Çakmak, Esra; Kablanoğlu, Serkan; Selçuk, Barin; Dursun, Nigar

    2016-01-01

    [Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group. [Conclusion] Early and two-stage reconstruction of patients with flexor tendon injuries can be performed with similarly favorable responses and effective rehabilitation programs. PMID:27630400

  5. Development of a synthetic replacement for the flexor tendon pulleys--an experimental study.

    PubMed

    Peterson, W W; Manske, P R; Lesker, P A; Kain, C C; Schaefer, R K

    1986-05-01

    A method was developed to reconstruct the fibro-osseous pulleys with Nitex, a synthetic material. Nitex is a closely woven fabric constructed from monofilament nylon fibers. Six adult monkeys (24 digits) had excision of the A1 and A2 pulleys; this was followed by reconstruction of the A2 pulley with the Nitex synthetic material. The animals were killed, two at a time, at 4, 8, and 12 weeks to evaluate the effectiveness of the Nitex pulleys. Flexor tendon function was assessed by biomechanical methods with a tensile testing machine to measure the tendon excursion and the work of flexion (the area under the force-excursion curve) necessary to fully flex each digit; these parameters revealed that the Nitex pulleys were capable of preventing tendon bow-stringing and did not significantly impair tendon gliding. The breaking strength of the Nitex pulleys was comparable to that of normal A2 pulleys (for monkeys weighing less than 10 kg) and it was sufficient to allow immediate mobilization of the digits postoperatively without fear of pulley rupture. Histologic examination showed minimal foreign body reaction around the Nitex, and the gliding surface of a Nitex pulley was found to be covered with a smooth layer of fibrous tissue with minimal adhesions to the underlying flexor tendon. The synthetic Nitex pulley appears to have the potential to function as an effective fibro-osseous pulley replacement.

  6. Monitoring hand flexor fatigue in a 24-h motorcycle endurance race.

    PubMed

    Marina, M; Porta, J; Vallejo, L; Angulo, R

    2011-04-01

    Motorcycle riders must endure high levels of muscle tension for long periods of time, especially in their arms and forearms, when steering and using handlebar controls. Because the right hand operates the gas handle and front brakes, the present research focuses on fatigue in the right hand flexors. Ten adult riders, aged 32.5±5.5years, volunteered to participate in this study. During the 24h race each rider, on completion of a relay stage, visited the assessment box to do the following handgrip test sequence: (1) 10s of EMG recording at rest, (2) one 3-s maximal voluntary contraction (MVC), (3) 1min rest interval and (4) 50% MVC maintained during 10s. EMG amplitude (MP: μV) and median and mean frequency (MF and MPF: Hz) over the superficial finger flexors were recorded during the whole handgrip test sequence with adhesive surface electrodes. MVC values were maintained during the first two relays (50-60min duration in total) and dropped gradually thereafter (p<0.01). During the monitoring of the 50% MVC, mean amplitude increased (p=0.024) while median and mean frequency tended to decrease. These results suggest fatigue is produced in motorcycle riders in a 24h race. However, the expected reduction of EMG frequency was not confirmed given to a potentially large variability.

  7. Reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio.

    PubMed

    Flansbjer, Ulla-Britt; Lexell, Jan

    2010-06-01

    To assess the reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio. A test-retest reliability study. Thirty men and women (mean age 63 (standard deviation 6.4) years) with verified late effects of polio. Knee extensor and flexor muscle strength in both lower limbs were measured twice 7 days apart using a Biodex dynamometer (isokinetic concentric contractions at 60 degrees /sec and isometric contractions with knee flexion angle 90 degrees) and a Leg Extension/Curl Rehab exercise machine with pneumatic resistance (HUR) (isotonic contractions). Reliability was assessed with the intraclass correlation coefficient (ICC1,1), the mean difference between the test sessions (d) together with the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and Bland-Altman graphs. Test-retest agreements were high, (ICC1,1 0.93-0.99) and measurement errors generally small. The SEM% was 4-14% and the SRD% 11-39%, with the highest values for the isokinetic measurements. Knee muscle strength can be measured reliably and can be used to detect real changes after an intervention for a group of persons with late effects of polio, whereas the values may be too high for single individuals or to detect smaller short-term changes over time for a group of individuals.

  8. Effects of Plantar Flexor Muscle Static Stretching Alone and Combined With Massage on Postural Balance

    PubMed Central

    2016-01-01

    Objective To evaluate and compare the effects of stretching and combined therapy (stretching and massage) on postural balance in people aged 50 to 65 years. Methods Twenty-three subjects participated in this nonrandomized clinical trial study. Each participant randomly received plantar flexor muscle stretching (3 cycles of 45 seconds with a 30-second recovery period between cycles) alone and in combination with deep stroking massage (an interval of at least 30 minutes separated the two interventions). The data were recorded with a force platform immediately after each condition with eyes open and closed. The center of pressure displacement and velocity along the mediolateral and anteroposterior axes were calculated under each condition. The data were analyzed with multiple-pair t-tests. Results The center of pressure displacement and velocity along the mediolateral axis increased after both stretching and the combined intervention. There were significant differences in both values between participants in the stretching and combined interventions (p<0.05). Conclusion Plantar flexor muscle stretching (for 45 seconds) combined with deep stroking massage may have more detrimental effects on postural balance than stretching alone because each intervention can intensify the effects of the other. PMID:27847714

  9. Repetitive differential finger motion increases shear strain between the flexor tendon and subsynovial connective tissue.

    PubMed

    Tat, Jimmy; Kociolek, Aaron M; Keir, Peter J

    2013-10-01

    Non-inflammatory fibrosis and thickening of the subsynovial connective tissue (SSCT) are characteristic in carpal tunnel syndrome (CTS) patients. These pathological changes have been linked to repetitive hand tasks that create shear forces between the flexor tendons and SSCT. We measured the relative motion of the flexor digitorum superficialis tendon and SSCT during two repetitive finger tasks using color Doppler ultrasound. Twelve participants performed flexion-extension cycles for 30 min with the long finger alone (differential movement) and with all four fingers together (concurrent movement). Shear strain index (SSI, a relative measure of excursion in flexion and extension) and maximum velocity ratio (MVR, the ratio of SSCT versus tendon during flexion and extension) were used to represent shear. A linear effect of exertion time was significant and corresponded with larger tendon shear in differential motion. The flexion SSI increased 20.4% from the first to the 30th minute, while MVR decreased 8.9% in flexion and 8.7% in extension. No significant changes were found during concurrent motion. These results suggest that exposure to repetitive differential finger tasks may increase the risk of shear injury in the carpal tunnel.

  10. A comparison of repair methods for gap healing in equine flexor tendon.

    PubMed

    Bertone, A L; Stashak, T S; Smith, F W; Norrdin, R W

    1990-01-01

    In nine horses (18 forelimbs), a 3 cm section of superficial digital flexor tendon was removed and the tendons were repaired with immobilization for 6 weeks and (1) no suture (n = 6); (2) a double locking loop tenorrhaphy with carbon fiber (n = 6); or (3) a double locking loop tenorrhaphy with size 2 nylon suture (n = 6). Clinical assessment, gross evaluation, morphometry, histology, and mechanical testing were performed on two limbs from each treatment group at weeks 6, 12, and 24. At weeks 6 and 12, the unsutured tissue was less mature than the tissue sutured with nylon. By week 24, the carbon fiber repair had breaking stress (mean, 12.5 M Pa) similar to the unsutured repair (mean, 10.6 M Pa). There was necrosis and a granulomatous foreign body reaction around the carbon fiber. The nylon suture repair had significantly greater strength per unit area (mean breaking stress, 20.4 M Pa) because of a smaller area of repair tissue in the gap (mean, 3.6 cm2). At week 24, the nylon suture repair tissue was the most mature with the least inflammation of the three repair methods. A nylon double locking loop suture was the preferred method for equine flexor tenorrhaphy of a tendon gap because of greater breaking stress, histologic maturity, biocompatibility, and the adequate functional and cosmetic outcome.

  11. Expression of growth factors in canine flexor tendon after laceration in vivo.

    PubMed

    Tsubone, Tetsu; Moran, Steven L; Amadio, Peter C; Zhao, Chunfeng; An, Kai-Nan

    2004-10-01

    Growth factors, transforming growth factor beta (TGF-beta), epidermal growth factor (EGF), platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF), are critical components of the cutaneous wound healing process. Little is known, however, about the expression of these growth factors in normal flexor tendon healing. In this study, we wished to examine which of these growth factors are present at 10 days following tendon injury in a canine flexor tendon repair model. Using immunohistochemical analysis, we found positive staining for all growth factors in both timing groups. TGF-beta was detected around the repair site and proximal to it. PDGF-AA, PDGF-BB and VEGF appeared in the whole tendon section following repair. EGF, IGF and bFGF were not seen in tenocytes but were present in inflammatory cells surrounding the repair site. These findings provide evidence that TGF-beta, EGF, PDGF-AA, PDGF-BB, IGF, bFGF and VEGF are all expressed at 10 days after tendon injury but by different cell types and in different locations. The time course of growth factor expression is an important element in wound healing, and a better understanding of where and when such factors are expressed may help in the development of methods to manipulate this expression, accelerate healing, and reduce adhesions.

  12. Resurfacing with Chemically Modified Hyaluronic Acid and Lubricin for Flexor Tendon Reconstruction

    PubMed Central

    Zhao, Chunfeng; Hashimoto, Takahiro; Kirk, Ramona L.; Thoreson, Andrew R.; Jay, Gregory D.; Moran, Steven L.; An, Kai-Nan; Amadio, Peter C.

    2013-01-01

    We assessed surface coating with carbodiimide derivatized hyaluronic acid combined with lubricin (cd-HA-Lubricin) as a way to improve extrasynovial tendon surface quality and, consequently, the functional results in flexor tendon reconstruction, using a canine in vivo model. The second and fifth flexor digitorum profundus tendons from 14 dogs were reconstructed with autologs peroneus longus (PL) tendons 6 weeks after a failed primary repair. One digit was treated with cd-HA-Lubricin, and the other was treated with saline as the control. Six weeks following grafting, the digits and graft tendons were functionally and histologically evaluated. Adhesion score, normalized work of flexion, graft friction in zone II, and adhesion breaking strength at the proximal repair site in zone III were all lower in the cd-HA-Lubricin treated group compared to the control group. The strength at the distal tendon/bone interface was decreased in the cd-HA-Lubricin treated grafts compared to the control grafts. Histology showed inferior healing in the cd-HA-Lubricin group at both proximal and distal repair sites. However, cd-HA-Lubricin treatment did not result in any gap or rupture at either the proximal or distal repair sites. These results demonstrate that cd-HA-Lubricin can eliminate graft adhesions and improve digit function, but that treatment may have an adverse effect on tendon healing. PMID:23335124

  13. Gliding characteristics between flexor tendons and surrounding tissues in the carpal tunnel: a biomechanical cadaver study.

    PubMed

    Zhao, Chunfeng; Ettema, Anke M; Osamura, Naoki; Berglund, Lawrence J; An, Kai-Nan; Amadio, Peter C

    2007-02-01

    The purpose of this study was to investigate the gliding characteristics of flexor tendons within the carpal tunnel with varied wrist positions and tendon motion styles, which may help us to understand the relationship between carpal tunnel syndrome (CTS) and repetitive hand motion. Eight fresh human cadaveric wrists and hands were used. The peak (PGR) and mean (MGR) gliding resistance of the middle finger flexor digitorum superficialis tendon were measured with the wrist in 0, 30, and 60 degrees of flexion and extension. While moving all three fingers together, the PGR at 60 degrees flexion was significantly higher than that at 0, 30, or 60 degrees extension. While moving the middle finger alone, the PGR at 60 and 30 degrees flexion was significantly higher than the PGR at 60 degrees extension. The PGR moving the middle finger FDS alone was significantly greater than that for all three digits moving together in 0, 30, and 60 degrees flexion. Differential finger motion with wrist flexion elevated the tendon gliding resistance in the carpal tunnel, which may be relevant in considering the possible role of wrist position and activity in the etiology of CTS.

  14. Validity of trunk extensor and flexor torque measurements using isokinetic dynamometry.

    PubMed

    Guilhem, Gaël; Giroux, Caroline; Couturier, Antoine; Maffiuletti, Nicola A

    2014-12-01

    This study aimed to evaluate the validity and test-retest reliability of trunk muscle strength testing performed with a latest-generation isokinetic dynamometer. Eccentric, isometric, and concentric peak torque of the trunk flexor and extensor muscles was measured in 15 healthy subjects. Muscle cross sectional area (CSA) and surface electromyographic (EMG) activity were respectively correlated to peak torque and submaximal isometric torque for erector spinae and rectus abdominis muscles. Reliability of peak torque measurements was determined during test and retest sessions. Significant correlations were consistently observed between muscle CSA and peak torque for all contraction types (r=0.74-0.85; P<0.001) and between EMG activity and submaximal isometric torque (r ⩾ 0.99; P<0.05), for both extensor and flexor muscles. Intraclass correlation coefficients were comprised between 0.87 and 0.95, and standard errors of measurement were lower than 9% for all contraction modes. The mean difference in peak torque between test and retest ranged from -3.7% to 3.7% with no significant mean directional bias. Overall, our findings establish the validity of torque measurements using the tested trunk module. Also considering the excellent test-retest reliability of peak torque measurements, we conclude that this latest-generation isokinetic dynamometer could be used with confidence to evaluate trunk muscle function for clinical or athletic purposes.

  15. Treatment of unfavourable results of flexor tendon surgery: Ruptured repairs, tethered repairs and pulley incompetence

    PubMed Central

    Elliot, David; Giesen, Thomas

    2013-01-01

    As primary repair of divided flexor tendons becomes more common, secondary tendon surgery becomes largely that of the complications of primary repair, namely ruptured and adherent repairs. These occur with an incidence of each in most reported series world-wide of around 5%, with these problems having changed little in the last two decades, despite strengthening our suture repairs. Where the primary referral service is less well-developed, and as a more occasional occurrence where primary treatment is the routine, the surgeon faces different problems. Patients arrive at a hand unit variable, but longer, times after the primary insult, having had no, or bad, previous treatment. Sometimes the situation is the same, viz. an extended finger with no active flexion, but now no longer amenable to primary repair. Frequently, it is much more complex as a result of injuries to the other tissues of the digit and, also, as a result of the unaided healing process within the digit in the presence of an inactive flexor system. We present our experience in dealing with ruptured repairs, tethered repairs and pulley incompetence. PMID:24459333

  16. Isometric torque-angle relationships of the elbow flexors and extensors in the transverse plane.

    PubMed

    Pinter, Ilona J; Bobbert, Maarten F; van Soest, A J Knoek; Smeets, Jeroen B J

    2010-10-01

    Maximal voluntary isometric torque-angle relationships of elbow extensors and flexors in the transverse plane (humerus elevation angle of 90 degrees ) were measured at two different horizontal adduction angles of the humerus compared to thorax: 20 degrees and 45 degrees . For both elbow flexors and extensors, the torque-angle relationship was insensitive to this 25 degrees horizontal adduction of the humerus. The peak in torque-angle relationship of elbow extensors was found at 55 degrees (0 degrees is full extension). This is closer to full elbow extension than reported by researchers who investigated this relationship in the sagittal plane. Using actual elbow angles during contraction, as we did in this study, instead of angles set by the dynamometer, as others have done, can partly explain this difference. We also measured electromyographic activity of the biceps and triceps muscles with pairs of surface electrodes and found that electromyographic activity level of the agonistic muscles was correlated to measured net torque (elbow flexion torque: Pearson's r=0.21 and extension torque: Pearson's r=0.53). We conclude that the isometric torque-angle relationship of the elbow extensors found in this study provides a good representation of the force-length relationship and the moment arm-angle relationship of the elbow extensors, but angle dependency of neural input gives an overestimation of the steepness. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  17. Unilateral eccentric exercise of the knee flexors affects muscle activation during gait.

    PubMed

    Dover, Geoffrey C; Legge, Laura; St-Onge, Nancy

    2012-05-01

    Uni-lateral muscle soreness is common yet the effects on gait or electromyographic (EMG) activity are unknown. The purpose of our study was to induce delayed onset muscle soreness (DOMS) in the knee flexor group and measure the resultant change in EMG activity and knee motion during gait. Nine healthy subjects participated in the study. Measures of function, evoked tenderness of the biceps femoris, as well as knee angle, and EMG activity during gait were assessed prior and 48 h after an eccentric exercise protocol. DOMS was induced unilaterally in the knee flexors using an isokinetic dynamometer and subjects exercised until they could not generate 50% of their maximal voluntary isometric contraction (MVIC). There was a significant decrease in biceps femoris activity after DOMS during the last phase of gait. Moreover, there was a day × phase interaction for gastrocnemius activity with the last two phases displaying an increase in activity. There was no significant change in knee angle during gait. The decrease in biceps femoris activity as well as the increase in gastrocnemius activity could be evidence of a protective mechanism designed to decrease activity of the sore muscle while increasing the activity of a synergistic muscle. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Effects of Plantar Flexor Muscle Static Stretching Alone and Combined With Massage on Postural Balance.

    PubMed

    Hemmati, Ladan; Rojhani-Shirazi, Zahra; Ebrahimi, Samaneh

    2016-10-01

    To evaluate and compare the effects of stretching and combined therapy (stretching and massage) on postural balance in people aged 50 to 65 years. Twenty-three subjects participated in this nonrandomized clinical trial study. Each participant randomly received plantar flexor muscle stretching (3 cycles of 45 seconds with a 30-second recovery period between cycles) alone and in combination with deep stroking massage (an interval of at least 30 minutes separated the two interventions). The data were recorded with a force platform immediately after each condition with eyes open and closed. The center of pressure displacement and velocity along the mediolateral and anteroposterior axes were calculated under each condition. The data were analyzed with multiple-pair t-tests. The center of pressure displacement and velocity along the mediolateral axis increased after both stretching and the combined intervention. There were significant differences in both values between participants in the stretching and combined interventions (p<0.05). Plantar flexor muscle stretching (for 45 seconds) combined with deep stroking massage may have more detrimental effects on postural balance than stretching alone because each intervention can intensify the effects of the other.

  19. A classic improved: minor tweaks yield major benefits in crayfish slow-flexor preparations.

    PubMed

    Weller, Cynthia; Hochhaus, A Maren; Wright, T Michael; Mulloney, Brian

    2015-01-01

    Action potentials and the postsynaptic potentials they evoke fill the pages of neuroscience textbooks, but students have relatively few opportunities to record these phenomena on their own. However, the act of making such recordings can be key events in a student's scientific education. The crayfish abdominal slow flexor muscle system is a well-established platform for recording spikes and PSPs. It enables students to see nerves and the muscles they innervate, record spontaneous spikes from several motor axons in these nerves as well as PSPs in their postsynaptic muscle fibers, and interpret these recordings quantitatively. Here we describe an improved method for preparing the slow-flexor system for recording that employs transmitted illumination through the stereo microscope's conventional substage lighting. Oblique transmitted lighting allows students to see the nerve and muscles fibers in each segment clearly and position recording electrodes accurately under visual control. Because students can see the nerves, muscles, and recording electrodes, broken electrode tips are relatively uncommon and the first successful recordings come more quickly. Many kinds of neurons in the CNS have the same pattern of multineuronal, multiterminal innervation that occurs on these muscle fibers. To visualize these innervation patterns on these fibers, we describe an immunohistochemical protocol that labels the GABAergic inhibitory motor axon and all the synaptic vesicles in the synaptic terminals on these muscle fibers. Dual-color images reveal extensive branching of the axons and fields of presynaptic terminals, only some of which are double-labeled for GABA.

  20. Flexor tendon tissue engineering: temporal distribution of donor tenocytes versus recipient cells.

    PubMed

    Thorfinn, Johan; Saber, Sepideh; Angelidis, Ioannis K; Ki, Sae H; Zhang, Andrew Y; Chong, Alphonsus K; Pham, Hung M; Lee, Gordon K; Chang, James

    2009-12-01

    Tissue-engineered tendon material may address tendon shortages in mutilating hand injuries. Tenocytes from rabbit flexor tendon can be successfully seeded onto acellularized tendons that are used as tendon constructs. These constructs in vivo exhibit a population of tenocyte-like cells; however, it is not known to what extent these cells are of donor or recipient origin. Furthermore, the temporal distribution is also not known. Tenocytes from New Zealand male rabbits were cultured and seeded onto acellularized rabbit forepaw flexor tendons (n = 48). These tendon constructs were transplanted into female recipients. Tendons were examined after 3, 6, 12, and 30 weeks using fluorescent in situ hybridization to detect the Y chromosome in the male donor cells. One unseeded, acellularized allograft in each animal was used as a control. The donor male tenocytes populate the epitenon and endotenon of the grafts at greater numbers than the recipient female tenocytes at 3 and 6 weeks. The donor and recipient tenocytes are present jointly in the grafts until 12 weeks. At 30 weeks, nearly all cells are recipient tenocyte-like cells. Donor male cells survive in decreasing numbers over time until 30 weeks. The presence of cells in tissue-engineered tendon grafts has been shown in prior studies to add to the strength of the constructs in vitro. This study shows that recipient cells can migrate into and repopulate the tendon construct. Cell seeding onto tendon material may create stronger constructs that will allow the initiation of motion earlier.

  1. Effects of motor imagery on hand function during immobilization after flexor tendon repair.

    PubMed

    Stenekes, Martin W; Geertzen, Jan H; Nicolai, Jean-Philippe A; De Jong, Bauke M; Mulder, Theo

    2009-04-01

    To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function. Randomized controlled trial. Tertiary referral hospital. Patients (N=28) after surgical flexor tendon repair were assigned to either an intervention group or a control group. Kinesthetic motor imagery of finger flexion movements during the postoperative dynamic splinting period. The central aspects of hand function were measured with a preparation time test of finger flexion in which subjects pressed buttons as fast as possible following a visual stimulus. Additionally, the following hand function modalities were recorded: Michigan Hand Questionnaire, visual analog scale for hand function, kinematic analysis of drawing, active total motion, and strength. After the immobilization period, the motor imagery group demonstrated significantly less increase of preparation time than the control group (P=.024). There was no significant influence of motor imagery on the other tested hand function (P>.05). All tests except kinematic analysis (P=.570) showed a significant improvement across time after the splinting period (P

  2. Reduced endurance of the cervical flexor muscles in patients with concurrent temporomandibular disorders and neck disability.

    PubMed

    Armijo-Olivo, Susan; Fuentes, Jorge P; da Costa, Bruno R; Major, Paul W; Warren, Sharon; Thie, Norman M R; Magee, David J

    2010-12-01

    Subjects with temporomandibular disorders (TMDs) have been found to have clinical signs and symptoms of cervical dysfunction. Although many studies have investigated the relationship between the cervical spine and TMD, no study has evaluated the endurance capacity of the cervical muscles in patients with TMD. Thus the objective of this study was to determine whether patients with TMD had a reduced endurance of the cervical flexor muscles at any level of muscular contraction when compared with healthy subjects. One hundred and forty-nine participants provided data for this study (49 subjects were healthy, 54 had myogenous TMD, and 46 had mixed TMD). There was a significant difference in holding time at 25% MVC between subjects with mixed TMD when compared to subjects with myogenous TMD and healthy subjects. This implies that subjects with mixed TMD had less endurance capacity at a lower level of contraction (25% MVC) than healthy subjects and subjects with myogenous TMD. No significant associations between neck disability, jaw disability, clinical variables and neck flexor endurance test were found. Copyright © 2010 Elsevier Ltd. All rights reserved.

  3. Evaluation of clinical and tenoscopic findings in the carpal flexor sheath of horses.

    PubMed

    Zetterström, Sandra M; Johansson, Bengt C; Carmalt, James L

    2017-07-01

    OBJECTIVE To evaluate clinical and tenoscopic findings in a large group of horses undergoing surgery of the carpal flexor sheath (CFS) and determine whether any of the presurgical clinical signs were associated with tenoscopic findings. ANIMALS 242 horses that had undergone diagnostic and therapeutic tenoscopy of the CFS because of aseptic tenosynovitis. PROCEDURES Medical and tenoscopic video records (when available) of 242 horses undergoing tenoscopy of the CFS at a single equine clinic between January 2005 and June 2014 were reviewed. Tenoscopic findings were categorized as present or absent, and tears in the deep digital flexor tendon (DDFT) were subjectively graded according to severity. Logistic regression analysis was used to examine whether presurgical clinical findings were associated with intraoperative tenoscopic findings. RESULTS 242 horses (411 limbs) were evaluated by use of tenoscopy. An exostosis was detected in 228 horses (379 limbs) and was often multipartite. Most exostoses were found medial to, or within, the sagittal plane at the caudal margin of the scar on the distal physis of the radius. Effusion in the CFS was associated with tears in the DDFT. Other presurgical clinical findings were not predictive of intrathecal findings. CONCLUSIONS AND CLINICAL RELEVANCE Synovial effusion was predictive of DDFT lesions within the CFS but was not predictive of the severity of lesions. Further studies will be necessary to determine whether any tenoscopic findings are associated with reduced athletic performance and to assess the effect of surgical intervention in affected horses.

  4. The effect of keyboard keyswitch make force on applied force and finger flexor muscle activity.

    PubMed

    Rempel, D; Serina, E; Klinenberg, E; Martin, B J; Armstrong, T J; Foulke, J A; Natarajan, S

    1997-08-01

    The design of the force-displacement characteristics or 'feel' of keyboard keyswitches has been guided by preference and performance data; there has been very little information on how switch 'feel' alters muscle activity or applied force. This is a laboratory-based repeated measures design experiment to evaluate the effect of computer keyboard keyswitch design on applied finger force and muscle activity during a typing task. Ten experienced typists typed on three keyboards which differed in keyswitch make force (0.34, 0.47 and 1.02 N) while applied fingertip force and finger flexor electromyograms were recorded. The keyboard testing order was randomized and subjects typed on each keyboard for three trials, while data was collected for a minimum of 80 keystrokes per trial. No differences in applied fingertip force or finger flexor EMG were observed during typing on keyboards with switch make force of 0.34 or 0.47 N. However, applied fingertip force increased by approximately 40% (p < 0.05) and EMG activity increased by approximately 20% (p < 0.05) when the keyswitch make force was increased from 0.47 to 1.02 N. These results suggest that, in order to minimize the biomechanical loads to forearm tendons and muscles of keyboard users, keyswitches with a make force of 0.47 N or less should be considered over switches with a make force of 1.02 N.

  5. Painful Pseudotendon of the Flexor Carpi Radialis Tendon: A Literature Review and Case Report.

    PubMed

    Van Demark, Robert E; Helsper, Elizabeth; Hayes, Meredith; Hayes, Matthew; Smith, Vanessa J S

    2017-09-01

    Flexor tendon ruptures in the wrist are uncommon. Flexor carpi radialis (FCR) tendon rupture can occur in rheumatoid patients, following cortisone injection for tenosynovitis, and following trauma. Following tendon rupture, tethering of the ruptured FCR tendon, or pseudotendon, can form which may or may not be symptomatic. A literature review was done reviewing treatment and outcomes of FCR tendon lesions. A case report of painful FCR pseudotendon following a fall is presented. The patient presented 4 months after injury with a tender lump 6 cm proximal to the wrist joint with pain and weakness aggravated with wrist motion and gripping. The literature review reveals operative excision of a symptomatic FCR pseudotendon lesion results in great patient satisfaction with no morbidity. In this case report, in spite of conservative measures including cortisone injection and activity modification, the patient had persistent symptoms. The patient proceeded with surgery for complete excision of both the painful pseudotendon and retracted FCR tendon stump. Post-operatively, his wrist motion and grip strength returned to normal, and his Disabilities of the Arm, Shoulder, and Hand (DASH) score was significantly improved from 72 to 9. FCR pseudotendon is an uncommon condition and can be seen following trauma. Majority of FCR tendon ruptures resolve with non-operative treatment. Based on the excellent outcomes following complete FCR tendon harvest for thumb carpometacarpal (CMC) joint reconstruction, complete excision of a symptomatic pseudotendon results in excellent relief of symptoms with no long-term morbidity.

  6. Human ankle plantar flexor muscle–tendon mechanics and energetics during maximum acceleration sprinting

    PubMed Central

    Schache, Anthony G.; Brown, Nicholas A. T.; Pandy, Marcus G.

    2016-01-01

    Tendon elastic strain energy is the dominant contributor to muscle–tendon work during steady-state running. Does this behaviour also occur for sprint accelerations? We used experimental data and computational modelling to quantify muscle fascicle work and tendon elastic strain energy for the human ankle plantar flexors (specifically soleus and medial gastrocnemius) for multiple foot contacts of a maximal sprint as well as for running at a steady-state speed. Positive work done by the soleus and medial gastrocnemius muscle fascicles decreased incrementally throughout the maximal sprint and both muscles performed more work for the first foot contact of the maximal sprint (FC1) compared with steady-state running at 5 m s−1 (SS5). However, the differences in tendon strain energy for both muscles were negligible throughout the maximal sprint and when comparing FC1 to SS5. Consequently, the contribution of muscle fascicle work to stored tendon elastic strain energy was greater for FC1 compared with subsequent foot contacts of the maximal sprint and compared with SS5. We conclude that tendon elastic strain energy in the ankle plantar flexors is just as vital at the start of a maximal sprint as it is at the end, and as it is for running at a constant speed. PMID:27581481

  7. Flexor tendon injuries of hand: experience at Pakistan Institute of Medical Sciences, Islamabad, Pakistan.

    PubMed

    Ahmad, Muhammad; Hussain, Syed Shahid; Tariq, Farhan; Rafiq, Zulqarnain; Khan, M Ibrahim; Malik, Saleem A

    2007-01-01

    Flexor tendon injury is one of the most common hand injuries. This initial treatment is of the utmost importance because it often determines the final outcome; inadequate primary treatment is likely to give poor long tem results. Various suture techniques have been devised for tendon repair but the modified Kessler's technique is the most commonly used. This study was conducted in order to know the cause, mechanism and the effects of early controlled mobilization after flexor tendon repair and to assess the range of active motion after flexor tendon repair in hand. This study was conducted at the department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad from 1st March 2002 to 31st August 2003. Only adult patients of either sex with an acute injury were included in whom primary or delayed primary tendon repair was undertaken. In all the patients, modified Kessler's technique was used for the repair using non-absorbable monofilament (Prolene 4-0). The wound was closed with interrupted non-absorbable, polyfilament (Silk 4-0) suture. A dorsal splint extending beyond the finger tip to proximal forearm was used with wrist in 20-30 degrees palmer flexion, metacarpophalangeal (MP) joint flexed at 60 degrees. Passive movements of fingers were started from the first post operative day, and for controlled, active movements, a dynamic splint was applied. During this study, 33 patients with 39 digits were studies. 94% of the patients had right dominated hand involvement. 51% had the complete flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) injuries. Middle and ring fingers were most commonly involved. Thumb was involved in 9% of the patients. Zone III(46%) was the commonest to be involved followed by zone II (28%). Laceration with sharp object was the most frequent cause of injury. Finger tip to distal palmer crease distance (TPD) was < 2.0 cm in 71% cases (average 2.4cm) at the end of 2nd postoperative week. Total number of

  8. Assessment of the presence of independent flexor digitorum superficialis function in the small fingers of professional string players: is this an example of natural selection?

    PubMed

    Godwin, Y; Wheble, G A C; Feig, C

    2014-01-01

    This study estimated the prevalence of independent flexor digitorum superficialis function in the small fingers of 90 violin and viola players. The hypothesis tested was that the independent digital movements required in this population would select out those with absent flexor digitorum superficialis function. Professional string players were tested clinically, using standard and modified tests, for flexor digitorum superficialis function. Two additional physical tests were applied: the gap and stretch tests. These tests assess ring finger movement once the small finger is placed and the instrument is held in the chin-hold position. A statistically significant reduction in the prevalence of absent flexor digitorum superficialis function was confirmed in the musicians compared with a control group and published meta-analysis. This suggests that independent flexor digitorum superficialis function is important for professional musicians playing at an elite level.

  9. Assessment of Muscle Pain Induced by Elbow-Flexor Eccentric Exercise

    PubMed Central

    Lau, Wing Yin; Blazevich, Anthony J.; Newton, Michael J.; Wu, Sam Shi Xuan; Nosaka, Kazunori

    2015-01-01

    Context: Delayed-onset muscle soreness (DOMS) is a common muscle pain that many people experience and is often used as a model of acute muscle pain. Researchers have reported the effects of various interventions on DOMS, but different DOMS assessment protocols used in these studies make it difficult to compare the effects. Objective: To investigate DOMS characteristics after elbow-flexor eccentric exercise to establish a standardized DOMS assessment protocol. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Ten healthy, untrained men (21–39 years). Intervention(s): Participants performed 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors. Main Outcome Measure(s): Indirect muscle-damage markers were maximal voluntary isometric contraction torque, range of motion, and serum creatine kinase activity. Muscle pain was assessed before exercise, immediately postexercise, and 1 to 5 days postexercise using (1) a visual analog scale (VAS), (2) a category ratio-10 scale (CR-10) when applying static pressure and palpation at different sites (3, 9, and 15 cm above the elbow crease), and (3) pressure-pain thresholds (PPTs) at 50 sites (pain mapping). Results: Maximal voluntary isometric contraction and range of motion decreased and creatine kinase activity increased postexercise, indicating muscle damage. Palpation induced greater pain than static pressure, and longitudinal and transverse palpations induced greater pain than circular palpation (P < .05). The PPT was lower in the medial region before exercise, but the pain-sensitive regions shifted to the central and distal regions of the biceps brachii at 1 to 3 days postexercise (P < .05). The VAS was correlated with the CR-10 scale (r = 0.91, P < .05) but not with the PPT (r = −0.28, P = .45). Conclusions: The way in which muscles are assessed affects the pain level score. This finding suggests that pain level and pain threshold cannot be used

  10. Synergistic Co-activation Increases the Extent of Mechanical Interaction between Rat Ankle Plantar-Flexors

    PubMed Central

    Tijs, Chris; van Dieën, Jaap H.; Baan, Guus C.; Maas, Huub

    2016-01-01

    Force transmission between rat ankle plantar-flexors has been found for physiological muscle lengths and relative positions, but only with all muscles maximally activated. The aims of this study were to assess intermuscular mechanical interactions between ankle plantar-flexors during (i) fully passive conditions, (ii) excitation of soleus (SO), (iii) excitation of lateral gastrocnemius (LG), and (iv) during co-activation of SO, and LG (SO&LG). We assessed effects of proximal lengthening of LG and plantaris (PL) muscles (i.e., simulating knee extension) on forces exerted at the distal SO tendon (FSO) and on the force difference between the proximal and distal LG+PL tendons (ΔFLG+PL) of the rat. LG+PL lengthening increased FSO to a larger extent (p = 0.017) during LG excitation (0.0026 N/mm) than during fully passive conditions (0.0009 N/mm). Changes in FSO in response to LG+PL lengthening were lower (p = 0.002) during SO only excitation (0.0056 N/mm) than during SO&LG excitation (0.0101 N/mm). LG+PL lengthening changed ΔFLG+PL to a larger extent (p = 0.007) during SO excitation (0.0211 N/mm) than during fully passive conditions (0.0157 N/mm). In contrast, changes in ΔFLG+PL in response to LG+PL lengthening during LG excitation (0.0331 N/mm) were similar (p = 0.161) to that during SO&LG excitation (0.0370 N/mm). In all conditions, changes of FSO were lower than those of ΔFLG+PL. This indicates that muscle forces were transmitted not only between LG+PL and SO, but also between LG+PL and other surrounding structures. In addition, epimuscular myofascial force transmission between rat ankle plantar-flexors was enhanced by muscle activation. However, the magnitude of this interaction was limited. PMID:27708589

  11. Firing of antagonist small-diameter muscle afferents reduces voluntary activation and torque of elbow flexors

    PubMed Central

    Kennedy, David S; McNeil, Chris J; Gandevia, Simon C; Taylor, Janet L

    2013-01-01

    During muscle fatigue, firing of small-diameter muscle afferents can decrease voluntary activation of the fatigued muscle. However, these afferents may have a more widespread effect on other muscles in the exercising limb. We examined if the firing of fatigue-sensitive afferents from elbow extensor muscles in the same arm reduces torque production and voluntary activation of elbow flexors. In nine subjects we examined voluntary activation of elbow flexors by measuring changes in superimposed twitches evoked by transcranial magnetic stimulation of the motor cortex during brief (2–3 s) maximal voluntary contractions (MVC). Inflation of a blood pressure cuff following a 2-min sustained MVC blocked blood flow to the fatigued muscle and maintained firing of small-diameter afferents. After a fatiguing elbow flexion contraction, maximal flexion torque was lower (26.0 ± 4.4%versus 67.9 ± 5.2% of initial maximal torque; means ±s.d.; P < 0.001) and superimposed twitches were larger (4.1 ± 1.1%versus 1.8 ± 0.2% ongoing MVC, P= 0.01) with than without ischaemia. After a fatiguing elbow extensor contraction, maximal flexion torque was also reduced (82.2 ± 4.9%versus 91.4 ± 2.3% of initial maximal torque; P= 0.007), superimposed twitches were larger (2.7 ± 0.7%versus 1.3 ± 0.2% ongoing MVC; P= 0.02) and voluntary activation lower (81.6 ± 8.2%versus 95.5 ± 6.9%; P= 0.04) with than without ischaemia. After a fatiguing contraction, voluntary drive to the fatigued muscles is reduced with continued input from small-diameter muscle afferents. Furthermore, fatigue of the elbow extensor muscles decreases voluntary drive to unfatigued elbow flexors of the same arm. Therefore, firing of small-diameter muscle afferents from one muscle can affect voluntary activation and hence torque generation of another muscle in the same limb. PMID:23652589

  12. Ulnar Neuropathy due to Volar/Ulnar Displacement of the Flexor Tendons after Open Carpal Tunnel Release: Case Report.

    PubMed

    Tanabe, Katsuhisa; Miyamoto, Nao

    2017-09-01

    Ulnar nerve neuropathy is a rare complication following the carpal tunnel release. Above all, compression neuropathy is much rare. We report an acute ulnar nerve neuropathy following open carpal tunnel release due to the volar and ulnar displacement of the flexor tendons from the carpal tunnel and review the literature.

  13. Inter-Rater Reliability of the Modified Ashworth Scale and Modified Modified Ashworth Scale in Assessing Poststroke Elbow Flexor Spasticity

    ERIC Educational Resources Information Center

    Kaya, Taciser; Goksel Karatepe, Altinay; Gunaydin, Rezzan; Koc, Aysegul; Altundal Ercan, Ulku

    2011-01-01

    The Modified Ashworth Scale (MAS) is commonly used in clinical practice for grading spasticity. However, it was modified recently by omitting grade "1+" of the MAS and redefining grade "2". The aim of this study was to investigate the inter-rater reliability of MAS and modified MAS (MMAS) for the assessment of poststroke elbow flexor spasticity.…

  14. Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation.

    PubMed

    Kostka, Joanna; Czernicki, Jan; Pruszyńska, Magdalena; Miller, Elżbieta

    The purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program. Thirty-one post-stroke patients (60.6±12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee (Fext, Fflex) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test. The rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of non-paretic limbs. At baseline examination muscle strength difference between both Fflexkg(-1) and Fextkg(-1) had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for Fextkg(-1) and, interestingly, even more prominent for Fflexkg(-1). MMEP can effectively increase muscle strength and functional capacity in post-stroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors. Copyright © 2017 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  15. Inter-Rater Reliability of the Modified Ashworth Scale and Modified Modified Ashworth Scale in Assessing Poststroke Elbow Flexor Spasticity

    ERIC Educational Resources Information Center

    Kaya, Taciser; Goksel Karatepe, Altinay; Gunaydin, Rezzan; Koc, Aysegul; Altundal Ercan, Ulku

    2011-01-01

    The Modified Ashworth Scale (MAS) is commonly used in clinical practice for grading spasticity. However, it was modified recently by omitting grade "1+" of the MAS and redefining grade "2". The aim of this study was to investigate the inter-rater reliability of MAS and modified MAS (MMAS) for the assessment of poststroke elbow flexor spasticity.…

  16. Desmotomy for treatment of chronic desmitis of the accessory ligament of the deep digital flexor tendon in a horse.

    PubMed Central

    Todhunter, P G; Schumacher, J; Finn-Bodner, S T

    1997-01-01

    Chronic lameness was determined to be caused by desmitis of the accessory ligament of the deep digital flexor tendon and adhesions associated with these 2 structures. Desmotomy of the accessory ligament, resection of adhesions, and controlled exercise during convalescence resulted in return to normal use without apparent lameness. Images Figure 1. Figure 2. PMID:9332748

  17. Effectiveness of a tongue-placed electrotactile biofeedback to improve ankle force sense following plantar-flexor muscles fatigue.

    PubMed

    Vuillerme, Nicolas; Boisgontier, Matthieu

    2009-11-01

    To assess the effectiveness of a tongue-placed electrotactile biofeedback system to improve ankle force sense following plantar-flexor muscles fatigue, 11 young healthy adults were asked to perform an isometric contra-lateral force ankle-matching task in two experimental conditions of No fatigue and Fatigue of the plantar-flexor muscles and two conditions of No biofeedback and Biofeedback. The underlying principle of the biofeedback consisted of supplying subjects with supplementary information about the force developed by the plantar-flexor muscles through electrical stimulation of the tongue. Measures of the overall accuracy and the variability of the force ankle-matching performances were determined using the absolute error and the variable error, respectively. Results showed that (1) the Fatigue condition yielded increased absolute and variable errors relative to the No fatigue condition in the No biofeedback condition, whereas (2) no significant difference between the two No fatigue and Fatigue conditions was observed in the Biofeedback condition. These results suggest that subjects were able to integrate augmented sensory information delivered through electrotactile stimulation of the tongue to suppress the adverse effect of plantar-flexor muscles fatigue on ankle force sense.

  18. Low-level laser therapy reduces the fatigue index in the ankle plantar flexors of healthy subjects.

    PubMed

    de Souza, Clécio Gabriel; Borges, Daniel Tezoni; de Brito Macedo, Liane; Brasileiro, Jamilson Simões

    2016-12-01

    Low-level laser therapy (LLLT) has been suggested as a resource capable of increasing resistance to fatigue and enhancing muscle performance through its metabolic and photochemical effects. This study evaluated the immediate effects of the application of LLLT on neuromuscular performance of the plantar ankle flexors in healthy subjects through a fatigue-induced protocol. This is a randomized controlled clinical trial, attended by 60 young and physically active volunteers of both genders. The subjects were randomly assigned into three groups, control, placebo, and laser, and underwent a preliminary evaluation of the isokinetic performance of plantar flexors and electromyographic activity of the soleus muscle to ensure homogeneity between groups. After the application of the respective intervention protocols, participants were induced to fatigue by performing 100 isokinetic concentric contractions of ankle plantar flexors at a speed of 90°/s. The dynamometric fatigue index (DFI) and median frequency were recorded during the fatigue protocol for comparison between groups. The group receiving the laser application showed significantly lower dynamometric fatigue index (p = 0.036) when compared to control and placebo groups. In relation to the median frequency during the fatigue test, there was a decrease in all groups, however with no differences between them. We suggest that LLLT being applied prior to exercise can reduce the fatigue index in the ankle plantar flexors of healthy subjects.

  19. Magnetic resonance diagnosis of tarsal tunnel syndrome due to flexor digitorum accessorius longus and peroneocalcaneus internus muscles.

    PubMed

    Duran-Stanton, Amelia M; Bui-Mansfield, Liem T

    2010-01-01

    Anomalous muscles of the ankle are common. Although they are often asymptomatic, they can sometimes cause tarsal tunnel syndrome. We report a case of tarsal tunnel syndrome due to flexor digitorum accessorius longus and peroneocalcaneus internus muscles diagnosed on magnetic resonance imaging. Recognition of the most common accessory muscles of the ankle on magnetic resonance imaging and tarsal tunnel syndrome are also reviewed.

  20. V1 and v2b interneurons secure the alternating flexor-extensor motor activity mice require for limbed locomotion.

    PubMed

    Zhang, Jingming; Lanuza, Guillermo M; Britz, Olivier; Wang, Zhi; Siembab, Valerie C; Zhang, Ying; Velasquez, Tomoko; Alvarez, Francisco J; Frank, Eric; Goulding, Martyn

    2014-04-02

    Reciprocal activation of flexor and extensor muscles constitutes the fundamental mechanism that tetrapod vertebrates use for locomotion and limb-driven reflex behaviors. This aspect of motor coordination is controlled by inhibitory neurons in the spinal cord; however, the identity of the spinal interneurons that serve this function is not known. Here, we show that the production of an alternating flexor-extensor motor rhythm depends on the composite activities of two classes of ventrally located inhibitory neurons, V1 and V2b interneurons (INs). Abrogating V1 and V2b IN-derived neurotransmission in the isolated spinal cord results in a synchronous pattern of L2 flexor-related and L5 extensor-related locomotor activity. Mice lacking V1 and V2b inhibition are unable to articulate their limb joints and display marked deficits in limb-driven reflex movements. Taken together, these findings identify V1- and V2b-derived neurons as the core interneuronal components of the limb central pattern generator (CPG) that coordinate flexor-extensor motor activity.

  1. Neural and Nonneural Contributions to Wrist Rigidity in Parkinson's Disease: An Explorative Study Using the NeuroFlexor

    PubMed Central

    Zetterberg, H.; Frykberg, G. E.; Gäverth, J.; Lindberg, P. G.

    2015-01-01

    Objective. The NeuroFlexor is a novel method incorporating a biomechanical model for the measurement of neural and nonneural contributions to resistance induced by passive stretch. In this study, we used the NeuroFlexor method to explore components of passive movement resistance in the wrist and finger muscles in subjects with Parkinson's disease (PD). Methods. A cross-sectional comparison was performed in twenty-five subjects with PD with clinically identified rigidity and 14 controls. Neural (NC), elastic (EC), and viscous (VC) components of the resistance to passive extension of the wrist were calculated using the NeuroFlexor. Measurements were repeated during a contralateral activation maneuver. Results. PD subjects showed greater total resistance (P < 0.001) and NC (P = 0.002) compared to controls. EC and VC did not differ significantly between groups. Contralateral activation maneuver resulted in increased NC in the PD group but this increase was due to increased resting tension. Total resistance and NC correlated with clinical ratings of rigidity and with bradykinesia. Conclusions. The findings suggest that stretch induced reflex activity, but not nonneural resistance, is the major contributor to rigidity in wrist muscles in PD. The NeuroFlexor is a potentially valuable clinical and research tool for quantification of rigidity. PMID:25685778

  2. Ultrasonographic diagnosis of porcupine quill foreign bodies in the plantar flexor tendon sheath region in a heifer.

    PubMed

    Mulon, Pierre-Yves; Achard, Damien; Babkine, Marie

    2010-08-01

    A 17-month-old Holstein heifer was presented for persistent enlargement above the right hind fetlock of 1-month's duration. Diffuse plantar soft tissue swelling was present on the radiographs and ultrasonography revealed the presence of multiple porcupine quill extremities embedded in the subcutaneous tissue within the flexor tendon sheath wall. Surgical removal was performed.

  3. A More Informed Evaluation of Medial Compartment Loading: the Combined Use of the Knee Adduction and Flexor Moments

    PubMed Central

    Manal, Kurt; Gardinier, Emily; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2015-01-01

    Objective To evaluate if the peak knee flexor moment provides unique and meaningful information about peak medial compartment loading above and beyond what is obtained from the peak knee adduction moment. Methods Standard video-based motion capture and EMG recordings were collected for 10 ACL reconstructed subjects walking at a self-selected speed. Knee joint moments were obtained using inverse dynamics and medial contact force was computed using an EMG-driven musculoskeletal model. Linear regression with the peak adductor moment entered first was implemented to isolate the unique contribution of the peak flexor moment to peak medial loading. Results Peak moments and medial contact force occurred during weight acceptance at approximately 23% of stance. The peak adduction moment (pKAM) was a significant predictor of peak medial loading (p = 0.004) accounting for approximately 63% of the variance. The peak knee flexor moment (pKFM) was also a significant predictor (p = 0.009) accounting for an additional 22% of the variance. When entered together pKAM and pKFM accounted for more than 85% of the variance in peak medial compartment loading. Conclusion The combined use of the peak knee flexor and adductor moments provides a significantly more accurate estimate of peak medial joint loading than the peak adduction moment alone. More accurate inferences of joint contact force will assist clinicians and researchers investigating relationships between joint loading and the onset and progression of knee OA. PMID:25862486

  4. V1 and V2b interneurons secure the alternating flexor-extensor motor activity mice require for limbed locomotion

    PubMed Central

    Zhang, Jingming; Lanuza, Guillermo M.; Britz, Olivier; Wang, Zhi; Siembab, Valerie C.; Zhang, Ying; Velasquez, Tomoko; Alvarez, Francisco J.; Frank, Eric; Goulding, Martyn

    2014-01-01

    SUMMARY The reciprocal activation of flexor and extensor muscles constitutes the fundamental mechanism that tetrapod vertebrates use for locomotion and limb-driven reflex behaviors. This aspect of motor coordination is controlled by inhibitory neurons in the spinal cord; however, the identity of the spinal interneurons that serve this function is not known. Here we show that the production of an alternating flexor-extensor motor rhythm depends on the composite activities of two classes of ventrally-located inhibitory neurons, V1 and V2b interneurons (INs). Abrogating V1 and V2b IN-derived neurotransmission in the isolated spinal cord results in a synchronous pattern of L2 flexor-related and L5 extensor-related locomotor activity. Mice lacking V1 and V2b inhibition are unable to articulate their limb joints and display marked deficits in limb-driven reflex movements. Taken together, these findings identify V1- and V2b-derived neurons as the core interneuronal components of the limb central pattern generator (CPG) that coordinate flexor-extensor motor activity. PMID:24698273

  5. The effects of biological lubricating molecules on flexor tendon reconstruction in a canine allograft model in vivo.

    PubMed

    Zhao, Chunfeng; Wei, Zhuang; Reisdorf, Ramona L; Thoreson, Andrew R; Jay, Gregory D; Moran, Steven L; An, Kai-Nan; Amadio, Peter C

    2014-05-01

    Using allograft is an attractive alternative for flexor tendon reconstruction because of the lack of donor-site morbidity, and better matching to the intrasynovial environment. The purpose of this study was to use biological lubricant molecules to modify the graft surface to decrease adhesions and improve digit function. Twenty-eight flexor digitorum profundus tendons from the second and fifth digits of 14 dogs were lacerated and repaired to create a model with repair failure and scar digit for tendon reconstruction. Six weeks after the initial operation, the tendons were reconstructed with flexor digitorum profundus allograft tendons obtained from canine cadavers. One graft tendon in each dog was treated with saline as a control and the other was treated with carbodiimide-derivatized hyaluronic acid and gelatin plus lubricin. Six weeks postoperatively, digit function, graft mechanics, and biology were analyzed. Allograft tendons treated with carbodiimide-derivatized hyaluronic acid-lubricin had decreased adhesions at the proximal tendon/graft repair and within the flexor sheath, improved digit function, and increased graft gliding ability. The treatment also reduced the strength at the distal tendon-to-bone repair, but the distal attachment rupture rate was similar for both graft types. Histologic evaluation showed that viable cells migrated to the allograft, but these were limited to the tendon surface. Carbodiimide-derivatized hyaluronic acid-lubricin treatment of tendon allograft improves digit functional outcomes after flexor tendon reconstruction. However, delayed bone-to-tendon healing should be a caution. Furthermore, the cell infiltration into the allograft tendon substance should be a target for future studies, to shorten the allograft self-regeneration period.

  6. Flexor Tendon Entrapment at the Malunited Base Fracture of the Proximal Phalanx of the Finger in Child: A Case Report.

    PubMed

    Lee, Young-Keun; Park, Soojin; Lee, Malrey

    2015-09-01

    The proximal phalangeal base is the most commonly fractured hand bone in children. Such fractures are rarely reported as irreducible due to flexor tendon entrapment. Here, we describe a patient who sustained a malunited fracture on the right fifth finger proximal phalanx with flexor tendon entrapment after treatment with closed reduction with K-wires fixation.A 13-year-old patient came to the clinic following a bicycle accident 6 weeks ago. He presented with flexion limitation in his small finger on the right hand. During physical examination, the patient felt no pain, and the neurovascular structures were intact. However range of motion (ROM) in his small finger was not normal. Plain radiographs displayed a Salter-Harris type II fracture of the small finger proximal phalanx base and volar angulation with callus formation. During the operation, it was established that the flexor digitorum superficialis (FDS) around the fracture had a severe adhesion, whereas the flexor digitorum profundus (FDP) was entrapped between the volarly displaced metaphyses and the epiphyses and united with the bone. We removed the volarly displaced metaphyses and freed FDP and repaired the A2 pulley. The bone was anatomically fixed with K-wires. In the treatment after the operation, on the 2nd day, the patient was permitted the DIP joint motion by wearing a dynamic splint.At the 12-months follow-up, the patient had regained full ROM with no discomfort and the proximal phalanx growth plate of the small finger closed naturally with normal alignment.When treating a proximal phalangeal base fracture in children, the possibility of flexor tendon entrapment should be considered and should be carefully dealt with in its treatment.

  7. A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair.

    PubMed

    Lawrence, Tom M; Davis, Tim R C

    2005-07-01

    Flexor tendon repair strength depends on the suture technique and the suture material used. Configurations that incorporate locking loops prevent sutures from pulling through the tendon but typically fail because of suture breakage. The choice of suture material therefore influences repair strength. This study investigated the mechanical properties of 5 nonabsorbable 4-0 suture materials (monofilament nylon, monofilament polypropylene, braided polyester, braided stainless steel wire, and braided polyethylene) and evaluated their performance when used in a locking 4-strand flexor tendon repair configuration. Five samples of 2 strands of each suture type were tested mechanically to determine the material stiffness and ultimate load. In addition, 50 fresh porcine flexor tendons were divided and repaired with each of the 5 suture materials using a 4-strand single-cross technique. Gap force, ultimate strength, and stiffness were measured to compare biomechanical performance. All repairs failed by suture rupture at the locking loop. Fibrewire and stainless-steel sutures and repairs were significantly stronger and stiffer than the other suture types. The results for Prolene and Ethibond were similar in the tendon repair groups with respect to gap and ultimate forces although Ethibond provided significantly increased repair stiffness. Nylon sutures and repairs consistently produced the poorest mechanical performance in all outcome measures. Suture material strongly influences the biomechanical performance of multistrand tendon repairs and is an important consideration for the surgeon. Fibrewire and stainless steel are the most biomechanically suitable suture materials for flexor tendon repair whereas nylon is the least suitable. Further developments in suture materials are important for advancements in flexor tendon repair strength.

  8. Retrieval of the retracted flexor tendons for long fingers: New tip.

    PubMed

    Ahed, K; Moujtahid, M; Nechad, M

    2014-09-01

    Zone II flexor tendon injuries continue to be a challenge for hand surgeons. During the injury event, the tendon ends may retract towards the palm. Retrieval of these lacerated ends can be problematic because the tendon sheath is unstretchable. This demanding surgery requires a precise repair technique where the tendon stumps are handled in an atraumatic manner. Microtrauma to the tendon sheath must be avoided as this can induce adhesions and lead to poor functional outcomes. Several retrieval methods for retracted tendon ends have been described in published studies. In this technical note, we will describe a technical variation that streamlines the surgical procedure and uses commonly available materials. This simple trick makes the procedure easier and avoids having to suture the tendon to the tubing. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Spastic wrist flexion in cerebral palsy. Pronator teres versus flexor carpi ulnaris transfer.

    PubMed

    Bisneto, Edgard de Novaes França; Rizzi, Nivea; Setani, Eliana Ogassawara; Casagrande, Livia; Fonseca, Joseane; Fortes, Glaucia

    2015-01-01

    Analize data on patients submitted to transfer of the pronator teres (PT) or the flexor carpi ulnaris (FCB) to the extensor carpi radialis longus/brevis (ECRL/B) in order to correct flexed wrist deformity in patients with cerebral palsy. Patients were divided into two groups: PT group and FCU group to ECRL/B. The results were evaluated by goniometry and by the functional hand test (FHT). Goniometry showed a statistically significant difference in favor of FCU transfer. There was no statistically significant difference regarding FHT. Both transfers PT and FCU to ECRB are good options to correct wrist flexion deformity in cerebral palsy. Level of Evidence III, Non-randomized Controlled Cohort/Follow-Up Study.

  10. Spastic wrist flexion in cerebral palsy. Pronator teres versus flexor carpi ulnaris transfer

    PubMed Central

    Bisneto, Edgard de Novaes França; Rizzi, Nivea; Setani, Eliana Ogassawara; Casagrande, Livia; Fonseca, Joseane; Fortes, Glaucia

    2015-01-01

    OBJECTIVE: Analize data on patients submitted to transfer of the pronator teres (PT) or the flexor carpi ulnaris (FCB) to the extensor carpi radialis longus/brevis (ECRL/B) in order to correct flexed wrist deformity in patients with cerebral palsy. METHOD: Patients were divided into two groups: PT group and FCU group to ECRL/B. The results were evaluated by goniometry and by the functional hand test (FHT). RESULTS: Goniometry showed a statistically significant difference in favor of FCU transfer. There was no statistically significant difference regarding FHT. CONCLUSION: Both transfers PT and FCU to ECRB are good options to correct wrist flexion deformity in cerebral palsy. Level of Evidence III, Non-randomized Controlled Cohort/Follow-Up Study. PMID:26207093

  11. Management of acute pyogenic flexor tenosynovitis: Literature review and current trends

    PubMed Central

    Giladi, Aviram M.; Malay, Sunitha; Chung, Kevin C.

    2016-01-01

    Pyogenic flexor tenosynovitis (PFT) is an aggressive closed-space infection that can result in severe morbidity. Although surgical treatment of PFT has been widely described, the role of antibiotic therapy is inadequately understood. We conducted a literature review of studies reporting on acute PFT management. Twenty-eight case series articles were obtained, all of which used surgical intervention with varied use of antibiotics. Inconsistencies amongst the studies limited summative statistical analysis. Our results showed that use of antibiotics as a component of therapy resulted in improved range of motion outcomes (54% excellent vs. 14% excellent), as did using catheter irrigation rather than open washout (71% excellent vs. 26% excellent). These studies showed benefits of early treatment of PFT and of systemic antibiotic use. As broad-spectrum antibiotics have changed the management of other infectious conditions, we must more closely evaluate consistent antibiotic use in PFT management. PMID:25670687

  12. Soft-tissue coverage of olecranon with musculocutaneous flexor carpi ulnaris flap.

    PubMed

    Andre, A; Bonnevialle, N; Grolleau, J-L; Mansat, P

    2014-12-01

    Coverage of the olecranon area is always challenging in traumatology. Because of the superficial situation of the bone, the absence of muscle, the thinness of the skin and the subcutaneous tissue locally, skin defects are not uncommon and can lead to exposure of hardware or prostheses. We report an original surgical technique using a musculocutaneous flap from the flexor carpi ulnaris (FCU) with a proximal pedicle to cover the olecranon area, detailing its limits and indications. The FCU flap has become our first-choice procedure to cover olecranon skin defects because of its low morbidity, its reliability, and its straightforward procedure, obviating the need for any microsurgery technique. Furthermore, it allows moving the elbow, immediately decreasing the risk of elbow stiffness. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. Myofascial force transmission between transferred rat flexor carpi ulnaris muscle and former synergistic palmaris longus muscle

    PubMed Central

    Maas, Huub; Huijing, Peter A.

    2011-01-01

    Summary We investigated the extent of mechanical interaction between rat flexor carpi ulnaris (FCU) and palmaris longus (PL) muscles following transfer of FCU to the distal tendons of extensor carpi radialis brevis and longus (ECRB/L) muscles. Five weeks after recovery from surgery, isometric forces exerted at the distal tendons of FCU and PL were quantified at various FCU lengths. PL was kept at a constant length. Changing the muscle-tendon complex length of transferred FCU (by maximally 3.5 mm) decreased PL force significantly (by 7%). A linear relationship was found between changes in FCU muscle belly length, being a measure of muscle relative positions, and PL force. These results indicate that despite transfer of FCU muscle to the extensor side of the forearm, changing FCU length still affects force transmission of its, now, antagonistic PL muscle. We conclude that a transferred muscle may still be mechanically linked to its former synergistic muscles. PMID:23738260

  14. Morphological and histochemical characteristics of muscle fibre types in the flexor carpi radialis of the dog.

    PubMed Central

    Latorre, R; Gil, F; Vázquez, J M; Moreno, F; Mascarello, F; Ramirez, G

    1993-01-01

    The canine flexor carpi radialis is subdivided into 2 portions. The radial portion which occupies one third of the cross-section is located caudomedially and is composed only of large type I fibres (43.53 +/- 0.6 microns minimum diameter) in levels close to the insertion. The cubital portion is located craniolaterally and contains fewer and smaller type I fibres (26.10 +/- 0.3 microns minimum diameter). It is hypothesised that the radial portion of the muscle, with its larger slow fibre population, contributes to forelimb postural function. The cubital portion, with its generally fast fibre population (IIA), may be more important in the muscle's recognised function (flexion of the carpal joint during locomotion). Images Fig. 1 Fig. 2 Fig. 3 PMID:8226286

  15. Traumatic dislocation of posterior tibial tendon by avulsion of flexor retinacular release. Reconstruction with suture anchors.

    PubMed

    Godino, M; Vides, M; Guerado, E

    2015-01-01

    Traumatic dislocation of the posterior tibial tendon (PTT) has a very low prevalence. It presents with pain and recurrent snapping on the posterior side of the medial malleolus after an ankle sprain while practicing sports. The diagnosis is based on clinical examination, supported by imaging techniques. The treatment must be always surgical. A 28 year old man sprained ankle his ankle while jogging. He was treated in an emergency department with an elastic bandage. Once he recovered, he went back to running, noticing a projection with ankle pain. In the physical examination the PTT was reproduced with inversion maneuvers and forced dorsiflexion. Ultrasound and MRI were performed on the ankle. The patient was operated on, leaving a stable ankle with no projection. Three months later he had no pain and restarted his physical activities. Surgical treatment of PTT dislocation by re-anchoring the flexor retinacula provides an excellent functional outcome. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  16. Biomechanical evaluation of wrist-driven flexor hinge orthosis in persons with spinal cord injury.

    PubMed

    Kang, Yeoun-Seung; Park, Yoon-Ghil; Lee, Bum-Suk; Park, Hyung-Soon

    2013-01-01

    The wrist-driven flexor hinge orthosis (WDFHO) is a device used to restore hand function in persons with tetraplegic spinal cord injury by furnishing three-point prehension. We assessed the effectiveness and biomechanical properties of the WDFHO in 24 persons with cervical 6 or 7 tetraplegia who have severely impaired hand function. This study introduces a mechanical operating model to assess the efficiency of the WDFHO. Experimental results showed that pinch force increased significantly (p < 0.001) after using the WDFHO and was found to positively correlate with the strength of wrist extensor muscles (r = 0.41, p < 0.001). However, when the strength of the wrist extensors acting on the WDFHO was greater, the reciprocal wrist and finger motion that generates three-point prehension was less effective (r = 0.79, p < 0.001). Reliable and valid biomechanical evaluation of the WDFHO could improve our understanding of its biomechanics.

  17. Placebo effects of caffeine on maximal voluntary concentric force of the knee flexors and extensors.

    PubMed

    Tallis, Jason; Muhammad, Bilal; Islam, Mohammed; Duncan, Michael J

    2016-09-01

    We examined the placebo effect of caffeine and the combined effect of caffeine and caffeine expectancy on maximal voluntary strength. Fourteen men completed 4 randomized, single-blind experimental trials: (1) told caffeine, given caffeine (5 mg/kg) (CC); (2) told caffeine, given placebo (CP); (3) told placebo, given placebo (PP); and (4) told placebo, given caffeine (PC). Maximal voluntary concentric force and fatigue resistance of the knee flexors and extensors were measured using isokinetic dynamometry. A significant and equal improvement in peak concentric force was found in the CC and PC trials. Despite participants believing caffeine would evoke a performance benefit, there was no effect of CP. Caffeine caused an improvement in some aspects of muscle strength, but there was no additional effect of expectancy. Performance was poorer in participants who believed caffeine would have the greatest benefit, which highlights a link between expected ergogenicity, motivation, and personality characteristics. Muscle Nerve 54: 479-486, 2016. © 2015 Wiley Periodicals, Inc.

  18. Graded arrangement of collagen fibrils in the equine superficial digital flexor tendon.

    PubMed

    Watanabe, Takafumi; Imamura, Yasutada; Hosaka, Yoshinao; Ueda, Hiromi; Takehana, Kazushige

    2007-01-01

    By using ultramorphological and biochemical methods, we analyzed the regional differences between the three parts of the equine superficial digital flexor tendon (SDFT), namely, the myotendinous junction (MTJ), middle metacarpal (mM), and osteotendinous junction (OTJ). Cross-sectional images showed unique distributions of collagen fibrils of varying diameters in each region. Small collagen fibrils (diameter <100 nm) were distributed predominantly in the MTJ region, and the OTJ region was relatively rich in large collagen fibrils (diameter >200 nm). In the mM region, the collagen fibrils were intermediately distributed between the MTJ and OTJ. The results indicate a graded arrangement of collagen fibrils in the tendon. Type V collagen was detected preferentially in the MTJ region. Since type V collagen is believed to be one of the collagens regulating collagen fibril formation, its possible functionality in the MTJ region in terms of fibril formation and fibril arrangement in the tendon has been discussed here.

  19. [Use of tissue engineering in the reconstruction of flexor tendon injuries of the hand].

    PubMed

    Bíró, Vilmos

    2015-02-08

    In his literary analysis, the author describes a novel method applied in the reconstruction of flexor tendon injuries of the hand. This procedure is named tissue engineering, and it is examined mainly under experimental circumstances. After definition of the method and descriptions of literary preliminaries the author discusses the healing process of the normal tendon tissue, then development of the scaffold, an important step of tissue engineering is described. After these topics the introduction of the pluripotent mesenchymal stem cells into the scaffold, and proliferation of these cells and development of the sliding systems are presented. The mechanical resisting ability of the formed tendon tissue is also discussed. Finally, the author concludes that as long as results of experimental research cannot be successfully applied into clinical practice, well-tried tendon reconstruction operations and high quality postoperative rehabilitation are needed.

  20. Feasibility of partial A2 and A4 pulley excision: effect on finger flexor tendon biomechanics.

    PubMed

    Mitsionis, G; Bastidas, J A; Grewal, R; Pfaeffle, H J; Fischer, K J; Tomaino, M M

    1999-03-01

    We investigated the effect of partial excision of the A2 and A4 digital pulleys, separately and in combination, on finger angular rotation and the energy for finger flexion. Statistically significant decreases in angular rotation resulted only after 50% and 75% excision of A2, A4, or A2 and A4 in combination. Work of flexion trends were weak and none of the changes were statistically significant. Although optimal finger function relies on the integrity of the A2 and A4 pulleys to maintain the efficiency of the digital flexor system, these data suggest that the A2 and A4 pulleys can be excised up to 25%, either separately or in combination, without significant effects on angular rotation. Decreases in total angular range of motion after 50% and 75% pulley excision were small, even for combined pulley excision (9 degrees +/- 3 degrees and 15 degrees +/- 5 degrees [mean +/- SD], respectively), and may be clinically acceptable.

  1. A repeated carpal tunnel syndrome due to tophaceous gout in flexor tendon

    PubMed Central

    Lu, Hui; Chen, Qiang; Shen, Hui

    2017-01-01

    Abstract Rationale: Gouty tophi is a rare cause of CTS. We first report a unique case of repeated CTS with gouty tophi in flexor tendon. In the previous literature, the symptoms cases of CTS were gradually increased. Patient concerns: We report a 44-year-old male porter presented with mass on his left distal forearm combined a repeated carpal tunnel syndrome for 5 years. He felt numbness in fingers and his left palmar. The CTS symptoms had been eased through rest and dugs medication. It recurred twice. Diagnoses: Monosodium urate crystal deposits were found in surgery. Histologic findings confirmed the diagnosis of gout. Interventions: We removed partial of gouty tophus and retained the integrity of the tendon. Outcomes: Two years after the surgery, the patient had not experienced any symptom recurrence. Lessons: Early diagnosis and control of gout are necessary to avoid irreversible complications. The surgery combined with decreasing trioxypurine treatment can improve the treatment outcome of gouty tophus. PMID:28248892

  2. Anatomical reference point for harvesting a flexor graft during arthroscopic reconstruction of the anterior cruciate ligament☆

    PubMed Central

    de Lima Lopes, Clécio; Arantes, Gabriel; de Oliveira, Rodrigo Victor Lapenda; Pinto, Dilamar Moreira; Gonçalves, Marcelo Carvalho Krause; Gonçalves, Romeu Carvalho Krause

    2015-01-01

    Objectives To evaluate the prevalence of a vascular network adjacent to the insertion of the pes anserinus, so that it could be used as an anatomical reference point to facilitate harvesting flexor grafts for arthroscopic reconstruction of the anterior cruciate ligament (ACL). Methods Thirty patients with ACL tears who were going to undergo ACL reconstruction using the tendons of the semitendinosus and gracilis muscles as grafts were selected randomly. During the harvesting of these tendons, the presence or absence of this anatomical reference point was noted. Results All the patients presented a vascular network of greater or lesser diameter. Conclusion The vascular network seems to be a good reference point during harvesting of the tendons of the semitendinosus and gracilis muscles, for facilitating graft harvesting. PMID:26229911

  3. Perceived exertion responses to novel elbow flexor eccentric action in women and men.

    PubMed

    O'Connor, Patrick J; Poudevigne, Melanie S; Pasley, Jeffrey D

    2002-05-01

    The primary aim was to describe perceived exertion responses to different intensities of eccentric exercise in women and men. 42 adults (21 men and 21 women, 7 per condition) completed elbow extension exercises with a weight corresponding to 80%, 100%, or 120% of maximal voluntary concentric strength. Total work was equated by manipulating the number of repetitions in the 80% (N = 45), 100% (N = 36), and 120% (N = 30) conditions. A two-way ANOVA showed significant main effects for the intensity and sex factors. Perceived exertion ratings were strongly dependent on exercise intensity, and women reported lower RPEs than men. A separate three-way mixed model ANOVA that included a repetition factor showed that perceived exertion ratings increased similarly across the first 30 repetitions in all exercise conditions. Significant partial correlations were found between mean RPE during the eccentric exercise bout, and the mean intensity of delayed-onset muscle pain measured from 12- to 72-h postexercise after controlling for the relative exercise intensity (r12.3 = 0.28) or the maximum concentric strength of the elbow flexors (r12.3 = 0.33). 1) for both women and men, there is a positive association between the intensity of eccentric exercise performed with the elbow flexors and RPE; 2) perceived exertion ratings increase significantly then plateau when repeated eccentric muscle actions are performed at constant, submaximal absolute intensities; 3) women rate eccentric exercise performed at the same intensity (relativized to MVC-C) as being less effortful compared with men; and 4) RPE during eccentric exercise can account for a small but significant amount of variability in delayed-onset muscle pain after statistically controlling for differences in strength or relative intensity.

  4. Anatomic comparison of lateral transfer of the long flexors for concomitant peroneal tears.

    PubMed

    Seybold, Jeffrey D; Campbell, John T; Jeng, Clifford L; Myerson, Mark S

    2013-12-01

    Lateral transfers of the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) tendons have been described for treatment of concomitant, irreparable peroneal tears. This study evaluated the anatomic benefits and constraints of lateral FHL and FDL tendon transfers with regard to available tendon length, diameter, and proximity to the posterior neurovascular bundle. In 9 cadaveric specimens, the FHL and FDL tendons were transected through a medial approach distal to the knot of Henry. Each tendon was transferred into a lateral incision, passing the FDL tendon both posterior and anterior to the tibial neurovascular bundle. The tendons were individually secured to the base of the fifth metatarsal with the foot in maximal eversion and dorsiflexion. The length of donor tendon available for fixation at the fifth metatarsal was measured. After the FDL tendon transfer was secured, the posterior neurovascular bundle was examined for signs of compression. Average FHL tendon diameter measured 5.1 mm; the FDL measured 4.5 mm. After passage through a bone tunnel, an additional 4.9 cm of FHL tendon remained to suture to itself; only 0.5 cm remained for the posterior and anterior FDL transfers. Transfer of the FHL did not increase muscle bulk within the retrofibular groove. Every FDL transfer posterior to the neurovascular bundle produced obvious visual compression of the tibial nerve with plantar flexion and inversion of the foot. Use of the FHL tendon for lateral transfer consistently provided sufficient length of tendon for multiple fixation options and a stronger muscle for transfer. Fixation options for the FDL were limited due to its shorter length. Lateral transfer of the FDL tendon posterior to the neurovascular bundle caused visible compression on the tibial nerve with ankle and hindfoot range of motion. This anatomic study confirmed several advantages for the use of the FHL tendon transfer in cases of concomitant peroneal tears.

  5. In vivo fascicle behavior of the flexor hallucis longus muscle at different walking speeds.

    PubMed

    Péter, A; Hegyi, A; Finni, T; Cronin, N J

    2017-02-03

    Ankle plantar flexor muscles support and propel the body in the stance phase of locomotion. Besides the triceps surae, flexor hallucis longus muscle (FHL) may also contribute to this role, but very few in vivo studies have examined FHL function during walking. Here, we investigated FHL fascicle behavior at different walking speeds. Ten healthy males walked overground at three different speeds while FHL fascicle length changes were recorded with ultrasound and muscle activity was recorded with surface electromyography (EMG). Fascicle length at heel strike at toe off and at peak EMG activity did not change with speed. Range of FHL fascicle length change (3.5-4.5 and 1.9-2.9 mm on average in stance and push-off phase, respectively), as well as minimum (53.5-54.9 and 53.8-55.7 mm) and maximum (58-58.4 and 56.8-57.7 mm) fascicle length did not change with speed in the stance or push-off phase. Mean fascicle velocity did not change in the stance phase, but increased significantly in the push-off phase between slow and fast walking speeds (P=.021). EMG activity increased significantly in both phases from slow to preferred and preferred to fast speed (P<.02 in all cases). FHL muscle fascicles worked near-isometrically during the whole stance phase (at least during slow walking) and operated at approximately the same length at different walking speeds. FHL and medial gastrocnemius (MG) have similar fiber length to muscle belly length ratios and, according to our results, also exhibit similar fascicle behavior at different walking speeds. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Muscle fibre types of the lumbrical, interossei, flexor, and extensor muscles moving the index finger.

    PubMed

    Hwang, Kun; Huan, Fan; Kim, Dae Joong

    2013-09-01

    The aim of this study was to determine the fibre types of the muscles moving the index fingers in humans. Fifteen forearms of eight adult cadavers were used. The sampled muscles were the first lumbrical (LM), first volar interosseous (VI), first dorsal interosseus (DI), second flexor digitorum profundus (FDP), second flexor digitorum superficialis (FDS), and extensor digitorum (ED). Six micrometer thick sections were stained for fast muscle fibres. The procedure was performed by applying mouse monoclonal anti-skeletal myosin antibody (fast) and avidin-biotin peroxidase complex staining. Rectangular areas (0.38 mm × 0.38 mm) were photographed and the boundaries of the muscle areas were marked on the translucent film. The numbers and sizes of the muscle fibres in each part were evaluated by the image analyser program and calculated per unit area (1 mm(2)). The proportion of the fast fibres was significantly (p = 0.012) greater in the intrinsic muscles (55.7 ± 17.1%) than in the extrinsic muscles (45.9 ± 17.1%). Among the six muscles, the VI had a significantly higher portion (59.3%) of fast fibres than the FDS (40.6%) (p = 0.005) or the FDP (45.1%) (p = 0.023). The density of the non-fast fibres was significantly (p = 0.015) greater in the extrinsic muscles (539.2 ± 336.8/mm(2)) than in the intrinsic muscles (383.4 ± 230.4/mm2). Since the non-fast fibres represent less fatigable fibres, it is thought that the extrinsic muscles have higher durability against fatigue, and the intrinsic muscles, including the LM, should move faster than the FDS or FDP because the MP joint should be flexed before the IP joint to grip an object.

  7. The effect of muscle loading on flexor tendon-to-bone healing in a canine model

    PubMed Central

    Thomopoulos, Stavros; Zampiakis, Emmanouil; Das, Rosalina; Silva, Matthew J.; Gelberman, Richard H.

    2008-01-01

    SUMMARY Previous tendon and ligament studies demonstrated a role for mechanical loading in tissue homeostasis and healing. In uninjured musculoskeletal tissues, increased loading leads to an increase in mechanical properties, while decreased loading leads to a decrease in properties. The role of loading on healing tissues is less clear. We studied tendon-to-bone healing in a canine flexor tendon-to-bone injury and repair model. To examine the effect of muscle loading on healing, repaired tendons were either cut proximally to remove all load from the distal phalanx repair site (unloaded group) or left intact proximally (loaded group). All paws were cast post-operatively and subjected to daily passive motion rehabilitation. Specimens were tested to determine functional properties, biomechanical properties, repair-site gapping, and bone mineral density. Loading across the repair site led to improved functional and biomechanical properties (e.g., stiffness for the loaded group was 8.2 ± 3.9 vs. 5.1 ± 2.5 N/mm for the unloaded group). Loading did not affect bone mineral density or gapping. The formation of a gap between the healing tendon and bone correlated with failure properties. Using a clinically relevant model of flexor tendon injury and repair, we found that muscle loading was beneficial to healing. Complete removal of load by proximal transection resulted in tendon-to-bone repairs with less range of motion and lower biomechanical properties compared to repairs in which the muscle-tendon-bone unit was left intact. PMID:18524009

  8. Evidence of isometric function of the flexor hallucis longus muscle in normal gait.

    PubMed

    Kirane, Y M; Michelson, J D; Sharkey, N A

    2008-01-01

    Studying mechanics of the muscles spanning multiple joints provides insights into intersegmental dynamics and movement coordination. Multiarticular muscles are thought to function at "near-isometric" lengths to transfer mechanical energy between the adjacent body segments. Flexor hallucis longus (FHL) is a multiarticular flexor of the great toe; however, its potential isometric function has received little attention. We used a robotic loading apparatus to investigate FHL mechanics during simulated walking in cadaver feet, and hypothesized that physiological force transmission across the foot can occur with isometric FHL function. The extrinsic foot tendons, stripped of the muscle fibers, were connected to computer-controlled linear actuators. The FHL activity was controlled using force-feedback (FC) based upon electromyographic data from healthy subjects, and subsequently, isometric positional feedback (PC), maintaining the FHL myotendinous junction stationary during simulated walking. Tendon forces and excursions were recorded, as were the strains within the first metatarsal. Forces in the metatarsal and metatarsophalangeal joint were derived from these strains. The FHL tendon excursion under FC was 6.57+/-3.13mm. The forces generated in the FHL tendon, metatarsal and metatarsophalangeal joint with the FHL under isometric PC were not significantly different in pattern from FC. These observations provide evidence that physiological forces could be generated along the great toe with isometric FHL function. A length servo mechanism such as the stretch reflex could likely control the isometric FHL function during in vivo locomotion; this could have interesting implications regarding the conditions of impaired stretch reflex such as spastic paresis and peripheral neuropathies.

  9. Differences in activation patterns in elbow flexor muscles during isometric, concentric and eccentric contractions.

    PubMed

    Nakazawa, K; Kawakami, Y; Fukunaga, T; Yano, H; Miyashita, M

    1993-01-01

    To investigate the relative activation of the synergistic muscles during three different types of muscle contraction, the electromyograms (EMG) of two elbow flexor muscles, the biceps brachii (BB) and the brachioradialis (BR), have been compared. To accomplish this eight healthy human subjects performed the following elbow flexions against the same load--concentric, eccentric and isometric contractions. The isometric contractions were performed at three elbow angles: 10, 45 and 90 degrees (0 degree equal to full extension). The EMG were recorded by bipolar surface electrodes, and the relative activation between the two muscles was evaluated as the quotient of mean EMG activities (BR/BB). For the isotonic elbow flexions, BR/BB were calculated at three angle divisions: 0-30 degrees, 30-60 degrees and 60-90 degrees. Results indicated that the relative activation of the BR during the concentric contractions was higher than that of the eccentric contraction, particularly at the extended elbow angles, i.e. the BR/BB of the concentric contractions for the elbow joint angles ranging from 0-30 degrees and 30-60 degrees were significantly greater (P < 0.05) than those of the eccentric contractions. During the isometric and eccentric contractions, the BR/BB at the flexed joint angles tended to be greater than those at the extended angles. In contrast, there were no angle-dependent BR/BB variations during the concentric elbow flexions. Further, changing patterns in the EMG power spectra due to the type of contraction were different between BB and BR. These results indicated that the activation pattern in the two elbow flexor muscles varied with the muscle contraction pattern.

  10. Drop punt kicking induces eccentric knee flexor weakness associated with reductions in hamstring electromyographic activity.

    PubMed

    Duhig, Steven J; Williams, Morgan D; Minett, Geoffrey M; Opar, David; Shield, Anthony J

    2017-06-01

    To examine the effect of 100 drop punt kicks on isokinetic knee flexor strength and surface electromyographic activity of bicep femoris and medial hamstrings. Randomized control study. Thirty-six recreational footballers were randomly assigned to kicking or control groups. Dynamometry was conducted immediately before and after the kicking or 10min of sitting (control). Eccentric strength declined more in the kicking than the control group (p<0.001; d=1.60), with greater reductions in eccentric than concentric strength after kicking (p=0.001; d=0.92). No significant between group differences in concentric strength change were observed (p=0.089; d=0.60). The decline in normalized eccentric hamstring surface electromyographic activity (bicep femoris and medial hamstrings combined) was greater in the kicking than the control group (p<0.001; d=1.78), while changes in concentric hamstring surface electromyographic activity did not differ between groups (p=0.863; d=0.04). Post-kicking reductions in surface electromyographic activity were greater in eccentric than concentric actions for both bicep femoris (p=0.008; d=0.77) and medial hamstrings (p<0.001; d=1.11). In contrast, the control group exhibited smaller reductions in eccentric than concentric hamstring surface electromyographic activity for bicep femoris (p=0.026; d=0.64) and medial hamstrings (p=0.032; d=0.53). Reductions in bicep femoris surface electromyographic activity were correlated with eccentric strength decline (R=0.645; p=0.007). Reductions in knee flexor strength and hamstring surface electromyographic activity are largely limited to eccentric contractions and this should be considered when planning training loads in Australian Football. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  11. Tenodesis for restoration of distal interphalangeal joint flexion in unrepairable flexor digitorum profundus injuries.

    PubMed

    Pritsch, Tamir; Sammer, Douglas M

    2014-01-01

    To describe in a cadaveric model a tenodesis procedure for restoring distal interphalangeal joint flexion in patients with unrepairable isolated flexor digitorum profundus (FDP) injuries. In 16 fresh-frozen cadaveric fingers, the FDP tendon was transected 1 cm proximal to its insertion to simulate an isolated zone I laceration. The injury was reconstructed using a palmaris longus tendon graft to create a mechanical linkage between the interphalangeal joints, which restored coordinated interphalangeal joint flexion. Joint motion and the force required to flex and extend the fingers were tested before and after the tenodesis. After FDP zone I laceration, distal interphalangeal joint flexion with load applied to the flexor digitorum superficialis tendon averaged 2°. The FDP flexion increased to a mean of 57° after the tenodesis. The sum of metacarpophalangeal, proximal interphalangeal and distal interphalangeal joint flexion averaged 186° before the tenodesis and increased to 233° after the tenodesis. The force required to achieve fingertip to palm contact and the force required to fully extend the proximal interphalangeal joint were not altered. In this cadaveric model, this tenodesis successfully restored coordinated interphalangeal joint flexion after a simulated zone I FDP laceration with improvements in distal interphalangeal joint flexion and composite finger flexion. Critical factors such as the effects of inflammation, edema, soft tissue healing, and scar formation could not be evaluated and would likely affect the outcomes of this procedure. The in vivo results of this procedure are not known. The potential use of this tenodesis for treating unrepairable isolated zone I FDP injuries was demonstrated in a cadaveric model. Further investigation of the outcomes and complications in vivo would be required before routine clinical use. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Alteration in neuromuscular function of the plantar flexors following caffeine ingestion.

    PubMed

    Behrens, Martin; Mau-Moeller, Anett; Heise, Sandra; Skripitz, Ralf; Bader, Rainer; Bruhn, Sven

    2015-02-01

    The aim of this study was to compare the neuromuscular function of the plantar flexors following caffeine or placebo administration. Thirteen subjects (25 ± 3 years) ingested caffeine or placebo in a randomized, controlled, counterbalanced, double-blind crossover design. Neuromuscular tests were performed before and 1 h after caffeine or placebo intake. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque, and neural drive to the muscles were measured. Triceps surae muscle activation was assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0-100 ms, 100-200 ms) and maximal voluntary contraction (MVC). Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during MVC, V-wave) and peak twitch torques were evaluated. The isometric maximum voluntary torque and evoked potentials were not different. However, we found a significant difference between groups for rate of torque development in the time intervals 0-100 ms [41.1 N · m/s (95% CI: 8.3-73.9 N · m/s, P = 0.016)] and 100-200 ms [32.8 N · m/s (95% CI: 2.8-62.8 N · m/s, P = 0.034)]. These changes were accompanied by enhanced neural drive to the plantar flexors. Data suggest that caffeine solely increased explosive voluntary strength of the triceps surae because of enhanced neural activation at the onset of contraction whereas MVC strength was not affected. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Primary flexor tendon repair in zones 1 and 2: early passive mobilization versus controlled active motion.

    PubMed

    Frueh, Florian Samuel; Kunz, Viviane Sylvie; Gravestock, Isaac Joseph; Held, Leonhard; Haefeli, Mathias; Giovanoli, Pietro; Calcagni, Maurizio

    2014-07-01

    To compare early passive mobilization (EPM) with controlled active motion (CAM) after flexor tendon surgery in zones 1 and 2. We performed a retrospective analysis of collected data of all patients receiving primary flexor tendon repair in zones 1 and 2 from 2006 to 2011, during which time 228 patients were treated, and 191 patients with 231 injured digits were eligible for study. Exclusion criteria were replantation, finger revascularization, age younger than 16 years, rehabilitation by means other than EPM or CAM, and missing information regarding postoperative rehabilitation. This left 132 patients with 159 injured fingers for analysis. The primary endpoint was the comparison of total active motion (TAM) values 4 and 12 weeks after surgery between the EPM and the CAM protocols. The analysis of TAM measurements under the rehabilitation protocols was conducted using t-tests and further linear modeling. We defined rupture rate and the assessment of adhesion/infection as secondary endpoints. There was a statistically significant difference between the TAM values of the EPM and the CAM protocols 4 weeks after surgery. At 12 weeks, however, there was no significant difference between the 2 protocols. Older age and injuries with finger fractures were associated with lower TAM values. Rupture rates were 5% (CAM) and 7% (EPM), which were not statistically different. This study showed a favorable effect of CAM protocol on TAM 4 weeks after surgery. The percent rupture rate was slightly lower in the patients with CAM than in the patients with EPM regime. Further studies are required to confirm our results and to investigate whether faster recovery of TAM is associated with shorter time out of work. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Influence of pelvis position on the activation of abdominal and hip flexor muscles.

    PubMed

    Workman, J Chad; Docherty, David; Parfrey, Kevin C; Behm, David G

    2008-09-01

    A pelvic position has been sought that optimizes abdominal muscle activation while diminishing hip flexor activation. Thus, the objective of the study was to investigate the effect of pelvic position and the Janda sit-up on trunk muscle activation. Sixteen male volunteers underwent electromyographic (EMG) testing of their abdominal and hip flexor muscles during a supine isometric double straight leg lift (DSLL) with the feet held approximately 5 cm above a board. The second exercise (Janda sit-up) was a sit-up action where participants simultaneously contracted the hamstrings and the abdominal musculature while holding an approximately 45 degrees angle at the knee. Root mean square surface electromyography was calculated for the Janda sit-up and DSLL under 3 pelvic positions: anterior, neutral, and posterior pelvic tilt. The selected muscles were the upper and lower rectus abdominis (URA, LRA), external obliques, lower abdominal stabilizers (LAS), rectus femoris, and biceps femoris. The Janda sit-up position demonstrated the highest URA and LRA activation and the lowest rectus femoris activation. The Janda sit-up and the posterior tilt were significantly greater (p < 0.01 and p < 0.05, respectively) than the anterior tilt for the URA and LRA muscles. Activation levels of the URA and LRA in neutral pelvis were significantly (p < 0.01 and p < 0.05, respectively) less than the Janda sit-up position, but not significantly different from the posterior tilt. No significant differences in EMG activity were found for the external obliques or LAS. No rectus femoris differences were found in the 3 pelvis positions. The results of this study indicate that pelvic position had a significant effect on the activation of selected trunk and hip muscles during isometric exercise, and the activation of the biceps femoris during the Janda sit-up reduced the activation of the rectus femoris while producing high levels of activation of the URA and LRA.

  15. The effect of muscle loading on flexor tendon-to-bone healing in a canine model.

    PubMed

    Thomopoulos, Stavros; Zampiakis, Emmanouil; Das, Rosalina; Silva, Matthew J; Gelberman, Richard H

    2008-12-01

    Previous tendon and ligament studies have demonstrated a role for mechanical loading in tissue homeostasis and healing. In uninjured musculoskeletal tissues, increased loading leads to an increase in mechanical properties, whereas decreased loading leads to a decrease in mechanical properties. The role of loading on healing tissues is less clear. We studied tendon-to-bone healing in a canine flexor tendon-to-bone injury and repair model. To examine the effect of muscle loading on tendon-to-bone healing, repaired tendons were either cut proximally (unloaded group) to remove all load from the distal phalanx repair site or left intact proximally (loaded group). All paws were casted postoperatively and subjected to daily passive motion rehabilitation. Specimens were tested to determine functional properties, biomechanical properties, repair-site gapping, and bone mineral density. Loading across the repair site led to improved functional and biomechanical properties (e.g., stiffness for the loaded group was 8.2 +/- 3.9 versus 5.1 +/- 2.5 N/mm for the unloaded group). Loading did not affect bone mineral density or gapping. The formation of a gap between the healing tendon and bone correlated with failure properties. Using a clinically relevant model of flexor tendon injury and repair, we found that muscle loading was beneficial to healing. Complete removal of load by proximal transection resulted in tendon-to-bone repairs with less range of motion and lower biomechanical properties compared to repairs in which the muscle-tendon-bone unit was left intact.

  16. Biomechanical risk factors and flexor tendon frictional work in the cadaveric carpal tunnel.

    PubMed

    Kociolek, Aaron M; Tat, Jimmy; Keir, Peter J

    2015-02-05

    Pathological changes in carpal tunnel syndrome patients include fibrosis and thickening of the subsynovial connective tissue (SSCT) adjacent to the flexor tendons in the carpal tunnel. These clinical findings suggest an etiology of excessive shear-strain force between the tendon and SSCT, underscoring the need to assess tendon gliding characteristics representative of repetitive and forceful work. A mechanical actuator moved the middle finger flexor digitorum superficialis tendon proximally and distally in eight fresh frozen cadaver arms. Eighteen experimental conditions tested the effects of three well-established biomechanical predictors of injury, including a combination of two wrist postures (0° and 30° flexion), three tendon velocities (50, 100, 150mm/sec), and three forces (10, 20, 40N). Tendon gliding resistance was determined with two light-weight load cells, and integrated over tendon displacement to represent tendon frictional work. During proximal tendon displacement, frictional work increased with tendon velocity (58.0% from 50-150mm/sec). There was a significant interaction between wrist posture and tendon force. In wrist flexion, frictional work increased 93.0% between tendon forces of 10 and 40N. In the neutral wrist posture, frictional work only increased 33.5% (from 10-40N). During distal tendon displacement, there was a similar multiplicative interaction on tendon frictional work. Concurrent exposure to multiple biomechanical work factors markedly increased tendon frictional work, thus providing a plausible link to the pathogenesis of work-related carpal tunnel syndrome. Additionally, our study provides the conceptual basis to evaluate injury risk, including the multiplicative repercussions of combined physical exposures. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Inhibitory action of forearm flexor muscle afferents on corticospinal outputs to antagonist muscles in humans

    PubMed Central

    Bertolasi, Laura; Priori, Alberto; Tinazzi, Michele; Bertasi, Valeria; Rothwell, John C

    1998-01-01

    To find out whether muscle afferents influence the excitability of corticospinal projections to antagonist muscles, we studied sixteen healthy subjects and one patient with a focal brain lesion. Using transcranial magnetic and electrical brain stimulation we tested the excitability of corticomotoneuronal connections to right forearm muscles at rest after conditioning stimulation of the median nerve at the elbow. Somatosensory potentials evoked by median nerve stimulation were also recorded in each subject. Test stimuli delivered at 13–19 ms after median nerve stimulation significantly inhibited EMG responses elicited in forearm extensor muscles by transcranial magnetic stimulation, but did not inhibit responses to electrical stimulation. In contrast, magnetically and electrically elicited responses in forearm flexor muscles were suppressed to the same extent. The higher the intensity of the test shocks, the smaller was the amount of median nerve-elicited inhibition. Inhibition in extensor muscles was also smaller during tonic wrist extension, or if the induced electrical stimulating current in the brain flowed from posterior to anterior over the motor strip rather than vice versa. Test responses evoked by magnetic transcranial stimulation in the first dorsal interosseous and in brachioradialis muscles were not inhibited after median nerve stimulation at the elbow. Stimulation of digital nerves failed to inhibit motor potentials in extensor muscles. Test stimuli delivered at 15 and 17 ms after radial nerve stimulation significantly inhibited EMG responses elicited in forearm flexor muscles by magnetic transcranial stimulation. In the patient with a focal thalamic lesion, who had dystonic postures and an absent N20 component of the somatosensory-evoked potentials but normal strength, median nerve stimulation failed to inhibit magnetically evoked responses in forearm extensor muscles. We propose that activation of median nerve muscle afferents can suppress the

  18. In vivo finger flexor tendon force while tapping on a keyswitch.

    PubMed

    Dennerlein, J T; Diao, E; Mote, C D; Rempel, D M

    1999-03-01

    Force may be a risk factor for musculoskeletal disorders of the upper extremity associated with typing and keying. However, the internal finger flexor tendon forces and their relationship to fingertip forces during rapid tapping on a keyswitch have not yet been measured in vivo. During the open carpal tunnel release surgery of five human subjects, a tendon-force transducer was inserted on the flexor digitorum superficialis of the long finger. During surgery, subjects tapped with the long finger on a computer keyswitch, instrumented with a keycap load cell. The average tendon maximum forces during a keystroke ranged from 8.3 to 16.6 N (mean = 12.9 N, SD = 3.3 N) for the subjects, four to seven times larger than the maximum forces observed at the fingertip. Tendon forces estimated from an isometric tendon-force model were only one to two times larger than tip force, significantly less than the observed tendon forces (p = 0.001). The force histories of the tendon during a keystroke were not proportional to fingertip force. First, the tendon-force histories did not contain the high-frequency fingertip force components observed as the tip impacts with the end of key travel. Instead, tendon tension during a keystroke continued to increase throughout the impact. Second, following the maximum keycap force, tendon tension during a keystroke decreased more slowly than fingertip force, remaining elevated approximately twice as long as the fingertip force. The prolonged elevation of tendon forces may be the result of residual eccentric muscle contraction or passive muscle forces, or both, which are additive to increasing extensor activity during the release phase of the keystroke.

  19. Responses of human elbow flexor muscles to electrically stimulated forced lengthening exercise.

    PubMed

    Nosaka, K; Newton, M; Sacco, P

    2002-02-01

    This study developed an electrical stimulation model for human elbow flexors to examine eccentric exercise-induced muscle damage and adaptation. Male students (n=17) were randomly placed into one of two groups; isometric (ES-ISO, n=8) and eccentric (ES-ECC, n=9). The elbow joint was fixed at 90 degrees (1.57 rad) and the elbow flexors stimulated percutaneously by an electronic muscle stimulator for 5 s through two electrodes placed over the muscles for ES-ISO. In ES-ECC, the muscles were stimulated similarly to the ES-ISO, but the elbow joint was forcibly extended from an elbow flexed (90 degrees 1.57 rad) to a full-extended position (180 degrees, 3.14 rad) in 3 s. Maximal voluntary isometric force, range of motion, upper arm circumference, muscle thickness by ultrasonography, muscle soreness, plasma creatine kinase and aspartate aminotransferase activities were assessed before and for 4 days after exercise. ES-ECC produced significantly larger changes in all criterion measures compared with ES-ISO (P < 0.01). These findings confirmed that eccentric muscle actions induced muscle damage, but isometric contractions resulted in little or no damage. Six subjects from the ES-ECC group repeated the same eccentric exercise (ECC2) 2 weeks after the first bout (ECC1), and changes in the criterion measures were compared between the bouts. Changes in all criterion measures after ECC2 were significantly smaller than ECC1 (P < 0.01). These results suggest that the first eccentric exercise produced a protective effect against muscle damage in the subsequent eccentric exercise bout, which does not involve adaptations in the central nervous system.

  20. Increases in M-wave latency of biceps brachii after elbow flexor eccentric contractions in women.

    PubMed

    Kouzaki, Karina; Nosaka, Kazunori; Ochi, Eisuke; Nakazato, Koichi

    2016-05-01

    Eccentric contractions (ECCs) induce muscle damage that is indicated by prolonged loss of muscle function and delayed onset muscle soreness. It is possible that ECCs affect motor nerves, and this may contribute to the prolonged decreases in force generating capability. The present study investigated the hypothesis that M-wave latency of biceps brachii would be increased after maximal elbow flexor ECCs resulting in prolonged loss of muscle strength. Fifteen women performed exercise consisting of 60 maximal ECCs of the elbow flexors using their non-dominant arm. M-wave latency was assessed by the time taken from electrical stimulation applied to the Erb's point to the onset of M-wave of the biceps brachii before, immediately after, and 1-4 days after exercise. Maximal voluntary isometric contraction (MVC) torque, range of motion (ROM) and muscle soreness using a numerical rating scale were also assessed before and after exercise. Prolonged decreases in MVC torque (1-4 days post-exercise: -54 to -15 %) and ROM (1-2 days: -32 to -22 %), and increased muscle soreness (peak: 4.2 out of 10) were evident after exercise (p < 0.05). The M-wave latency increased (p < 0.01) from 5.8 ± 1.0 ms before exercise to 6.5 ± 1.7 ms at 1 day and 7.2 ± 1.5 ms at 2 days after exercise for the exercised arm only. No significant changes in M-wave amplitude were evident after exercise. The increased M-wave latency did not fully explain the prolonged decreases in MVC torque after eccentric exercise, but may indicate reversible motor nerve impairment.

  1. Reduced short-interval intracortical inhibition after eccentric muscle damage in human elbow flexor muscles.

    PubMed

    Pitman, Bradley M; Semmler, John G

    2012-09-01

    The purpose of this study was to use paired-pulse transcranial magnetic stimulation (TMS) to examine the effect of eccentric exercise on short-interval intracortical inhibition (SICI) after damage to elbow flexor muscles. Nine young (22.5 ± 0.6 yr; mean ± SD) male subjects performed maximal eccentric exercise of the elbow flexor muscles until maximal voluntary contraction (MVC) force was reduced by ∼40%. TMS was performed before, 2 h after, and 2 days after exercise under Rest and Active (5% MVC) conditions with motor-evoked potentials (MEPs) recorded from the biceps brachii (BB) muscle. Peripheral electrical stimulation of the brachial plexus was used to assess maximal M-waves, and paired-pulse TMS with a 3-ms interstimulus interval was used to assess changes in SICI at each time point. The eccentric exercise resulted in a 34% decline in strength (P < 0.001), a 41% decline in resting M-wave (P = 0.01), changes in resting elbow joint angle (10°, P < 0.001), and a shift in the optimal elbow joint angle for force production (18°, P < 0.05) 2 h after exercise. This was accompanied by impaired muscle strength (27%, P < 0.001) and increased muscle soreness (P < 0.001) 2 days after exercise, which is indicative of muscle damage. When the test MEP amplitudes were matched between sessions, we found that SICI was reduced by 27% in resting and 23% in active BB muscle 2 h after exercise. SICI recovered 2 days after exercise when muscle pain and soreness were present, suggesting that delayed onset muscle soreness from eccentric exercise does not influence SICI. The change in SICI observed 2 h after exercise suggests that eccentric muscle damage has widespread effects throughout the motor system that likely includes changes in motor cortex.

  2. Difference in the magnitude of muscle damage between elbow flexors and knee extensors eccentric exercises

    PubMed Central

    Saka, Tolga; Akova, Bedrettin; Yazici, Zeynep; Sekir, Ufuk; Gür, Hakan; Ozarda, Yesim

    2009-01-01

    The aim of this study was to investigate the difference in the magnitude of muscle damage between maximal eccentric exercises of the elbow flexors (EF) and knee extensors (KE). Twelve sedentary male volunteers participated in the study. Range of motion (ROM), isometric peak torque (IPT), delayed onset of muscle soreness (DOMS), creatine kinase activity (CK), and myoglobin concentration (Mb) were evaluated before, immediately after, and on the 1st , 2nd, 3rd , and 7th days following exercise. Total work (TW) during exercises was recorded and corrected by muscle volume (TWc). TWc was greater (p < 0.01) for EF [24 (2) joule·cm-3] than for KE [7 (0.4) joule·cm-3]. Increases in CK on the 2nd , 3rd , and 7th days (p < 0.01) and increases in Mb on the 1st , 2nd , 3rd , and 7th days were significantly (p<0.01) larger for EF than for KE. The decline in IPT was greater (p < 0.05- 0.01) for EF at all test occasions compared with KE. The results of this study demonstrate that the magnitude of muscle damage is greater and the recovery is slower following maximal eccentric exercise of the EF than of the KE for sedentary males. Key points The magnitude of muscle damage is greater and the recovery is slower following maximal eccentric exercise of the EF than of the KE for sedentary males. This may be because of the higher total eccentric work per muscle unit in elbow flexors. PMID:24150563

  3. Human flexor tendon tissue engineering: in vivo effects of stem cell reseeding.

    PubMed

    Schmitt, Taliah; Fox, Paige M; Woon, Colin Y; Farnebo, Simon J; Bronstein, Joel A; Behn, Anthony; Pham, Hung; Chang, James

    2013-10-01

    Tissue-engineered human flexor tendons may be an option to aid in reconstruction of complex upper extremity injuries with significant tendon loss. The authors hypothesize that human adipose-derived stem cells remain viable following reseeding on human tendon scaffolds in vivo and aid in graft integration. Decellularized human flexor tendons harvested from fresh-frozen cadavers and reseeded with green fluorescent protein-labeled pooled human adipose-derived stem cells were examined with bioluminescent imaging and immunohistochemistry. Reseeded repaired tendons were compared biomechanically with unseeded controls following implantation in athymic rats at 2 and 4 weeks. The ratio of collagen I to collagen III at the repair site was examined using Sirius red staining. To confirm cell migration, reseeded and unseeded tendons were placed either in contact or with a 1-mm gap for 12 days. Green fluorescent protein signal was then detected. Following reseeding, viable cells were visualized at 12 days in vitro and 4 weeks in vivo. Biomechanical testing revealed no significant difference in ultimate load to failure and 2-mm gap force. Histologic evaluation showed host cell invasion and proliferation of the repair sites. No increase in collagen III was noted in reseeded constructs. Cell migration was confirmed from reseeded constructs to unseeded tendon scaffolds with tendon contact. Human adipose-derived stem cells reseeded onto decellularized allograft scaffolds are viable over 4 weeks in vivo. The movement of host cells into the scaffold and movement of adipose-derived stem cells along and into the scaffold suggests biointegration of the allograft.

  4. Enhanced expression of Wnt9a in the flexor tenosynovium in idiopathic carpal tunnel syndrome.

    PubMed

    Yamanaka, Yoshiaki; Menuki, Kunitaka; Zenke, Yukichi; Hirasawa, Hideyuki; Sakai, Akinori

    2015-10-01

    This study aimed to clarify the association between abnormal Wnt signaling and the cause of idiopathic carpal tunnel syndrome (ICTS) and whether an association exists between Wnt signaling and cell proliferation in the flexor tenosynovium. The subjects included nine patients with ICTS; the controls were nine patients with distal radius fractures without any symptoms of carpal tunnel syndrome. We extracted mRNA from the flexor tenosynovium and compared the expression levels of genes encoding 17 types of Wnt in both subjects and controls via quantitative real-time polymerase chain reaction (PCR). Expression levels of factors involved in cell proliferation, such as estrogen-responsive finger protein, epidermal growth factor receptor, heparin binding-epidermal growth factor-like growth factor, insulin-like growth factor-1, and vascular endothelial growth factor (VEGF) were also measured using quantitative real-time PCR. In addition, we compared the Wnt and MIB-1 protein expression levels to clarify the effect of Wnt on cell proliferation. Quantitative real-time PCR revealed significantly greater expression of the gene encoding Wnt9a in subjects with ICTS than in controls and also revealed a positive correlation between the expression of genes encoding Wnt9a and VEGF in subjects with ICTS. Quantitative evaluation using immunohistochemical staining also indicated more marked Wnt9a expression in subjects than in controls. However, there was no relationship between the expression of Wnt9a and the cell proliferation index MIB-1. These results indicate that Wnt9a expression is enhanced in ICTS and that Wnt9a may be involved in VEGF expression in ICTS. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  5. Contractile properties of muscle fibers from the deep and superficial digital flexors of horses.

    PubMed

    Butcher, M T; Chase, P B; Hermanson, J W; Clark, A N; Brunet, N M; Bertram, J E A

    2010-10-01

    Equine digital flexor muscles have independent tendons but a nearly identical mechanical relationship to the main joint they act upon. Yet these muscles have remarkable diversity in architecture, ranging from long, unipennate fibers ("short" compartment of DDF) to very short, multipennate fibers (SDF). To investigate the functional relevance of the form of the digital flexor muscles, fiber contractile properties were analyzed in the context of architecture differences and in vivo function during locomotion. Myosin heavy chain (MHC) isoform fiber type was studied, and in vitro motility assays were used to measure actin filament sliding velocity (V(f)). Skinned fiber contractile properties [isometric tension (P(0)/CSA), velocity of unloaded shortening (V(US)), and force-Ca(2+) relationships] at both 10 and 30°C were characterized. Contractile properties were correlated with MHC isoform and their respective V(f). The DDF contained a higher percentage of MHC-2A fibers with myosin (heavy meromyosin) and V(f) that was twofold faster than SDF. At 30°C, P(0)/CSA was higher for DDF (103.5 ± 8.75 mN/mm(2)) than SDF fibers (81.8 ± 7.71 mN/mm(2)). Similarly, V(US) (pCa 5, 30°C) was faster for DDF (2.43 ± 0.53 FL/s) than SDF fibers (1.20 ± 0.22 FL/s). Active isometric tension increased with increasing Ca(2+) concentration, with maximal Ca(2+) activation at pCa 5 at each temperature in fibers from each muscle. In general, the collective properties of DDF and SDF were consistent with fiber MHC isoform composition, muscle architecture, and the respective functional roles of the two muscles in locomotion.

  6. Further evaluation of an EMG technique for assessment of the deep cervical flexor muscles.

    PubMed

    Falla, D; Jull, G; O'Leary, S; Dall'Alba, P

    2006-12-01

    A novel surface electromyographic (EMG) technique was recently described for the detection of deep cervical flexor muscle activity. Further investigation of this technique is warranted to ensure EMG activity from neighbouring muscles is not markedly influencing the signals recorded. This study compared deep cervical flexor (DCF) muscle activity with the activity of surrounding neck and jaw muscles during various anatomical movements of the neck and jaw in 10 volunteer subjects. DCF EMG activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid, anterior scalene, masseter and suprahyoid muscles. Positioned in supine, subjects performed isometric cranio-cervical flexion, cervical flexion, right and left cervical rotation, jaw clench and resisted jaw opening. Across all movements examined, EMG amplitude of the DCF muscles was greatest during neck movements that would require activity of the DCF muscles, particularly during cranio-cervical flexion, their primary anatomical action. The actions of jaw clench and resisted jaw opening demonstrated significantly less DCF EMG activity than the cranio-cervical flexion action (p<0.05). Across all other movements, the neighbouring neck and jaw muscles demonstrated greatest EMG amplitude during their respective primary anatomical actions, which occurred in the absence of increased EMG amplitude recorded from the DCF muscles. The finding of substantial EMG activity of the DCF muscles only during neck actions that would require their activity, particularly cranio-cervical flexion, and not during actions involving the jaw, provide further assurance that the majority of myoelectric signals detected from the nasopharyngeal electrode are from the DCF muscles.

  7. The clinical and biomechanical effects of fascial-muscular lengthening therapy on tight hip flexor patients with and without low back pain

    PubMed Central

    Avrahami, Daniel; Potvin, Jim R.

    2014-01-01

    Background: Many patients have tight hip flexors with or without low back pain. Manual fascial-muscular lengthening therapy (FMLT) is one commonly used treatment for this population. Objective: Investigate the clinical and biomechanical effects of manual FMLT on tight hip flexor patients with and without low back pain. Methods: A nonrandomized trial, before-and-after experiment with multiple baselines conducted on two different patient populations: 1) Mechanical low back pain patients with tight hip flexors (n = 10) and 2) Asymptomatic group with tight hip flexors (n = 8). Four treatments of manual FMLT were performed on the hip flexor of the two groups of patients over a two-week period. Primary outcome measures over the two-week period were 1) Maximum voluntary trunk flexor and extensor moments, 2) Disability (Roland Morris Disability Questionnaire) and pain (10-cm Visual Analogue Scale), 3) Passive hip extension mobility. Results: Primary outcome analysis involved within-groups comparisons. Maximum voluntary trunk extension demonstrated increases for the low back pain patients. The low back pain patients demonstrated a small, but significant, reduction in disability and pain. Both groups demonstrated an increase in passive hip extension measurements. Conclusion: This preliminary study demonstrated interesting results from manual FMLT on two tight hip flexor patient populations with and without low back pain. However, there were several significant limitations from this study, which restrict the ability to generalize the results. PMID:25550670

  8. Relative longitudinal motion of the finger flexors, subsynovial connective tissue, and median nerve before and after carpal tunnel release in a human cadaver model.

    PubMed

    Yamaguchi, Taihei; Osamura, Naoki; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C

    2008-01-01

    The normal gliding environment in the carpal tunnel is complex. The median nerve and flexor tendons are surrounded by a multilayered subsynovial tissue. To date, observations of the relative motions of the flexor tendon, median nerve and multilayered subsynovial tissue have been through a surgically released open carpal tunnel. The purpose of this study was to compare the motions of these tissues in an intact and open carpal tunnel. We measured the relative motion of the middle finger flexor digitorum superficialis tendon, its surrounding subsynovial connective tissue (SSCT) and the median nerve in 8 human cadavers. The flexor retinaculum was used as a fixed reference point. The motions were compared for simulated isolated middle finger and simulated fist motion as measured fluoroscopically in the closed carpal tunnel and directly in the open carpal tunnel. While the simulated isolated finger motion produced significantly less SSCT and median nerve motion (p<.05), there was no difference in flexor digitorum superficialis, SSCT, or nerve motion when comparing the fluoroscopic measurements in the closed carpal tunnel with the direct visual measurements in the open carpal tunnel. Relative motion of the flexor tendons, SSCT, and median nerve within the carpal tunnel follows a certain pattern, which may indicate the physiological state of the SSCT. This relative motion pattern was not affected by flexor retinaculum release.

  9. The change in deep cervical flexor activity after training is associated with the degree of pain reduction in patients with chronic neck pain.

    PubMed

    Falla, Deborah; O'Leary, Shaun; Farina, Dario; Jull, Gwendolen

    2012-09-01

    Altered activation of the deep cervical flexors (longus colli and longus capitis) has been found in individuals with neck pain disorders but the response to training has been variable. Therefore, this study investigated the relationship between change in deep cervical flexor muscle activity and symptoms in response to specific training. Fourteen women with chronic neck pain undertook a 6-week program of specific training that consisted of a craniocervical flexion exercise performed twice per day (10 to 20 min) for the duration of the trial. The exercise targets the deep flexor muscles of the upper cervical region. At baseline and follow-up, measures were taken of neck pain intensity (visual analogue scale, 0 to 10), perceived disability (Neck Disability Index, 0 to 50) and electromyography (EMG) of the deep cervical flexors (by a nasopharyngeal electrode suctioned over the posterior oropharyngeal wall) during performance of craniocervical flexion. After training, the activation of the deep cervical flexors increased (P<0.0001) with the greatest change occurring in patients with the lowest values of deep cervical flexor EMG amplitude at baseline (R(2)=0.68; P<0.001). There was a significant relationship between initial pain intensity, change in pain level with training, and change in EMG amplitude for the deep cervical flexors during craniocervical flexion (R(2)=0.34; P<0.05). Specific training of the deep cervical flexor muscles in women with chronic neck pain reduces pain and improves the activation of these muscles, especially in those with the least activation of their deep cervical flexors before training. This finding suggests that the selection of exercise based on a precise assessment of the patients' neuromuscular control and targeted exercise interventions based on this assessment are likely to be the most beneficial to patients with neck pain.

  10. Potassium-efflux channels in extensor and flexor cells of the motor organ of Samanea saman are not identical. Effects of cytosolic calcium.

    PubMed

    Moshelion, M; Moran, N

    2000-10-01

    Leaflet movements in the mimosa-family tree Samanea saman stem from coordinated volume changes of cells in the leaf motor organs in the adaxial and abaxial motor cells ("flexors" and "extensors"). Shrinking, initiated by dissimilar light signals in extensors and in flexors, depends in both cell types on K(+) efflux via depolarization-dependent potassium (K(D)) channels. To compare between flexor and extensor K(D) channels and to test for a possible interaction of these channels with the Ca(2+)-mobilizing phosphoinositide cascade evoked in these motor cells by the "shrinking signals," we probed the channels with varying (5 nM-3 mM) cytosolic free-Ca(2+) concentration ([Ca(2+)](cyt)) in patch-clamped inside-out excised membrane patches. Ca(2+) was not required for K(D) channel activation. [Ca(2+)](cyt) of 600 nM decreased the mean number of open K(D) channels in flexors, as monitored at -30 mV. Detailed analysis revealed that in flexors millimolar [Ca(2+)](cyt) decreased the maximum number of open channels, but simultaneously increased K(D) channel opening probability by negatively shifting the half-maximum-activation voltage by 40 to 50 mV. Thus, the promoting and the inhibitory effects at millimolar [Ca(2+)](cyt) practically cancelled-out. In contrast to flexors, none of the gating parameters of the extensor K(D) channels were affected by [Ca(2+)](cyt). Irrespective of [Ca(2+)](cyt), the steady-state gating of extensor K(D) channels was slightly but significantly more voltage sensitive than that of flexors. The unitary conductances of flexor and extensor K(D) channels were similar and decreased by approximately 20% at millimolar [Ca(2+)](cyt). It is intriguing that the extensor K(D) channels were significantly less K(+) selective than those in flexors.

  11. Comparison of the DAS28-CRP and DAS28-ESR in patients with rheumatoid arthritis.

    PubMed

    Sengul, Ilker; Akcay-Yalbuzdag, Seniz; Ince, Bugra; Goksel-Karatepe, Altinay; Kaya, Taciser

    2015-07-01

    To compare the Disease Activity Score with 28 joint (DAS28) using erythrocyte sedimentation rate (ESR) (DAS28-ESR) and DAS28 using C-reactive protein (CRP) (DAS28-CRP) with thresholds validated for DAS28-ESR in Turkish patients with rheumatoid arthritis. The DAS28 data of 112 patients with rheumatoid arthritis followed in a local outpatient clinic were used. First, the correlation between DAS28-CRP and DAS28-ESR and the correlation between their unique components ([0.36 × In (CRP + 1) + 0.96] and [0.70 × In (ESR)]) were analyzed. Second, a Bland-Altman plot was constructed for the evaluation of the level of agreement between DAS28-CRP and DAS28-ESR. Lastly, the agreement between these two methods was analyzed by κ coefficient. Although there was a strong correlation between DAS28-CRP and DAS28-ESR, the correlation between their unique components was fair. Although more than 95% of the point data fall between the upper and lower bounds of the limit of agreement, the percentage error (46%) was higher than the acceptable proportion of 30%. The κ coefficient of agreement between DAS28- ESR and DAS28-CRP with validated thresholds for DAS28-ESR was 0.42, which was close to the lower boundary for moderate agreement. The results of this study demonstrated that there is discordance between DAS28-ESR and DAS28-CRP with the validated thresholds for DAS28-ESR. Using the DAS28-CRP with threshold values validated for DAS28-ESR may lead to errors in the determination of disease activity and therefore may lead to errors in the management of patients with rheumatoid arthritis. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  12. A novel device using the Nordic hamstring exercise to assess eccentric knee flexor strength: a reliability and retrospective injury study.

    PubMed

    Opar, David A; Piatkowski, Timothy; Williams, Morgan D; Shield, Anthony J

    2013-09-01

    Reliability and case-control injury study. To determine if a novel device designed to measure eccentric knee flexor strength via the Nordic hamstring exercise displays acceptable test-retest reliability; to determine normative values for eccentric knee flexor strength derived from the device in individuals without a history of hamstring strain injury (HSI); and to determine if the device can detect weakness in elite athletes with a previous history of unilateral HSI. HSI and reinjury are the most common cause of lost playing time in a number of sports. Eccentric knee flexor weakness is a major modifiable risk factor for future HSI. However, at present, there is a lack of easily accessible equipment to assess eccentric knee flexor strength. Thirty recreationally active males without a history of HSI completed the Nordic hamstring exercise on the device on 2 separate occasions. Intraclass correlation coefficients, typical error, typical error as a coefficient of variation, and minimal detectable change at a 95% confidence level were calculated. Normative strength data were determined using the most reliable measurement. An additional 20 elite athletes with a unilateral history of HSI within the previous 12 months performed the Nordic hamstring exercise on the device to determine if residual eccentric muscle weakness existed in the previously injured limb. The device displayed high to moderate reliability (intraclass correlation coefficient = 0.83-0.90; typical error, 21.7-27.5 N; typical error as a coefficient of variation, 5.8%-8.5%; minimal detectable change at a 95% confidence level, 60.1-76.2 N). Mean ± SD normative eccentric flexor strength in the uninjured group was 344.7 ± 61.1 N for the left and 361.2 ± 65.1 N for the right side. The previously injured limb was 15% weaker than the contralateral uninjured limb (mean difference, 50.3 N; 95% confidence interval: 25.7, 74.9; P<.01), 15% weaker than the normative left limb (mean difference, 50.0 N; 95

  13. Degree of thoracic kyphosis and peak torque of trunk flexors and extensors among healthy women☆☆☆

    PubMed Central

    Granito, Renata Neves; Aveiro, Mariana Chaves; Rennó, Ana Claudia Muniz; Oishi, Jorge; Driusso, Patricia

    2014-01-01

    Objective The aim of this study was to analyze the effects of aging on the degree of thoracic kyphosis and peak torque of the trunk flexor and extensor muscles among women without a densitometric diagnosis of osteoporosis. Methods Thirty women were selected to make up three groups: young women (n = 10; 24.60 ± 2.27 years of age); adults (n = 10; 43.50 ± 2.88); and elderly women (n = 10; 62.40 ± 2.67). Bone mineral density (BMD), degree of thoracic kyphosis and peak torque of the trunk flexors and extensors were evaluated. Differences between the groups were evaluated using the Kruskal–Wallis ANOVA and Mann–Whitney U tests. Pearson's correlation coefficient was used to assess correlations between the variables. The significance level was taken to be 5% (p ≤ 0.05). Results The elderly group presented a greater degree of thoracic kyphosis (p = 0.009) and lower peak torque of the trunk flexors and extensors than the young group. The adult group presented lower peak torque of the trunk than the young group. A negative correlation was observed between age and peak torque of the trunk flexors and extensors (p ≤ 0.001), and a positive correlation between age and the degree of thoracic kyphosis (r = 0.58; p ≤ 0.001). The elderly group presented higher values for the eccentric/concentric ratio of the peak torque for flexors (p = 0.03) and extensors (p = 0.02). Conclusion This study suggests that physiological aging may be associated with a greater degree of thoracic kyphosis and lower muscle strength of the trunk flexors and extensors. Moreover, the elderly women showed a relative capacity for preservation of eccentric strength. PMID:26229814

  14. Association of force steadiness of plantar flexor muscles and postural sway during quiet standing by young adults.

    PubMed

    Oshita, Kazushige; Yano, Sumio

    2012-08-01

    This study was conducted to assess the relations of force fluctuations during isometric plantar-flexion and postural sway during quiet standing. Twelve healthy men (M age = 21 yr., SD = 1) performed unilateral plantar flexion measured by a strain gauge force transducer. Participants performed force-matching tasks; sustained plantar flexion for 20 sec. at levels corresponding to 10% and 20% of maximum voluntary contraction with the visual feedback. Also, participants were asked to stand quietly with their eyes open, and then the center of mass displacement and velocity in the anteroposterior were measured. In analysis, postural sway was associated with force fluctuation at only 10% of maximum voluntary contraction. The statistically significant correlation between variables was found only at corresponding contraction intensities for plantar-flexor muscles. From this one may infer neural strategies in plantar-flexor muscles during quiet standing may be characteristics similar to those controlling the plantar-flexion force in young adults.

  15. Do the dimensions of the distal phalanges allow suture anchor fixation of the flexor digitorum profundus? A cadaver study.

    PubMed

    Jain, D K; Kakarala, G; Compson, J; Singh, R

    2011-10-01

    This study was done to identify whether the dimensions of the distal phalanges allow suture anchor fixation of the flexor digitorum profundus tendon. Forty pairs of hands were dissected to measure the anteroposterior and lateral dimensions of distal phalanges of all digits. The mean anteroposterior depth of the distal phalanx at the insertion of the tendon was found to be 4.7 mm for the little finger, 5.4 mm for the ring finger, 5.9 mm for the middle finger, 5.4 mm for the index finger and 6.9 mm for the thumb respectively. The commonly available anchors and drill bits for fingers were found to be suboptimal for anchoring the flexor digitorum profundus tendon to the distal phalanx of the little finger. The drill bits used for these anchors were found to be too long for the little fingers and some ring and index fingers.

  16. An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy.

    PubMed

    Latheef, L; Bhardwaj, P; Sankaran, A; Sabapathy, S R

    2017-02-01

    This study reports an objective assessment of postoperative function of 11 triple transfers for high radial palsies, using pronator teres for wrist extension, flexor carpi ulnaris for finger extension and palmaris longus for thumb extension. The mean follow-up was 3.3 years. Assessment was done by recording the active ranges of wrist motion, grip strength, wrist and finger strength and work simulation. The mean strength and range of wrist extension were 42% and 86%, respectively, of the contralateral wrist. Other measured movements were within the functional range and work simulation confirmed good restoration of function. The mean DASH score was 3.45, with no patient reporting any specific functional complaints. This study shows that even though the range of wrist motion and the strength of the wrist and fingers are less than normal, hand function remains good. We conclude that the flexor carpi ulnaris set of tendon transfer works well. 3.

  17. Oral baclofen increases maximal voluntary neuromuscular activation of ankle plantar flexors in children with spasticity due to cerebral palsy.

    PubMed

    van Doornik, Johan; Kukke, Sahana; McGill, Kevin; Rose, Jessica; Sherman-Levine, Sara; Sanger, Terence D

    2008-06-01

    Although spasticity is a common symptom in children with cerebral palsy, weakness may be a much greater contributor to disability. We explore whether a treatment that reduces spasticity may also have potential benefit for improving strength. Ten children with cerebral palsy and spasticity in the ankle plantar flexor muscles were treated with oral baclofen for 4 weeks. We tested voluntary ability to activate ankle plantar flexor muscles using the ratio of the surface electromyographic signal during isometric maximal voluntary contraction to the M-wave during supramaximal electrical stimulation of the tibial nerve and tested muscle strength using maximal isometric plantar flexion torque. Mean maximal voluntary neuromuscular activation increased from 1.13 +/- 1.02 to 1.60 +/- 1.30 ( P < .05) after treatment, corresponding to an increase in 9 of 10 subjects. Mean maximal plantar flexion torque did not change. We conjecture that antispasticity agents could facilitate strength training by increasing the ability to voluntarily activate muscle.

  18. Endoscopic-Assisted Flexor Hallucis Longus Transfer: Harvest of the Tendon at Zone 2 or Zone 3.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Flexor hallucis longus (FHL) tendon transfer is indicated for reconstruction of the Achilles tendon with a gap larger than 5 cm. The tendon can be harvested at zone 2 or zone 3 by minimally invasive techniques with the advantage of minimal soft-tissue dissection. The tendon can be harvested under the sustentaculum tali by zone 2 FHL tendoscopy. It is adequate for FHL transfer to the posterior calcaneal tubercle. If a double-thickness reconstruction of a huge gap of the Achilles tendon is indicated, the tendon can be harvested at the level of the hallux by means of a tendon stripper. However, the interconnection tendon of the master knot of Henry can be split together with the FHL or flexor digitorum longus tendon instead of being cut. Zone 2 FHL tendoscopy can be used to release the split tendon to complete the FHL harvest.

  19. Anatomical variations of flexor hallucis longus tendon increase safety in hindfoot endoscopy.

    PubMed

    Vega, Jordi; Redó, David; Savín, Gabriela; Malagelada, Francesc; Dalmau-Pastor, Miki

    2017-06-01

    The flexor hallucis longus (FHL) tendon is the main anatomical landmark during hindfoot endoscopy, and anatomical variations related to the FHL can pose a risk to the tibial nerve and posterior tibial vessels during hindfoot endoscopy. The aim of this study was to determine the distance between the FHL tendon and the tibial neurovascular bundle in the posterior ankle joint when an anatomical variant of the FHL is present. The hypothesis was that the shortest distance between the tibial neurovascular bundle and the FHL tendon in the working area of the hindfoot endoscopy is increased when an anatomical variant of the FHL is present. A retrospective review was performed using consecutive ankle magnetic resonance imaging (MRI) scans obtained during 1 year. All scans with anatomical variations related to the FHL were included in the study. A control group including scans without anatomical variations was obtained for comparison. The shortest distance between the FHL tendon and the neurovascular tibial bundle was measured in both groups. Three-hundred and fifty-five ankle MRIs were reviewed. 35 scans with anatomical variants of the FHL (9.8%) were found and comprised the study group that was compared to 35 scans without variants (control group). The mean distance from FHL to the neurovascular tibial bundle in the control group was 0.9 mm. The study group consisted of 18 cases with distal muscle belly insertion (5.1%), and 17 cases with an accessory tendon corresponding to a flexor digitorum accessorius longus (4.5%). In these subgroups, the mean distance from FHL to the neurovascular tibial bundle was 1.1 and 1.5 mm respectively. Overall this distance was found to be higher in the group with anatomical variants (1.3 mm) when compared to the control group (0.9 mm) (p < 0.05). During hindfoot endoscopy, the presence of an anatomical variant related to the FHL tendon has proven safer anatomically than in its absence, due to the increased distance between the FHL

  20. Anatomical study for flexor hallucis longus tendon transfer in treatment of Achilles tendinopathy.

    PubMed

    Mao, Haijiao; Shi, Zengyuan; Wapner, Keith L; Dong, Wenwei; Yin, Weigang; Xu, Dachuan

    2015-08-01

    The purpose of the study was to describe the anatomical variations of the connection between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons in the knot of Henry in Asians, and quantify the length of FHL tendon graft with different incisions. Sixty-four embalmed feet of 32 cadavers were analyzed anatomically with respect to the individual cross-links in the planta pedis. Single incision technique graft length was measured from the musculotendinous junction of FHL and the point at sustentaculum tali. Double incision technique was measured from musculotendinous junction of FHL and the level of the master knot of Henry. Additionally, minimally invasive incision technique was measured from musculotendinous junction of FHL to the first interphalangeal joint. These three techniques were then combined to determine the total potential tendon graft length obtainable using different approach. Only two different configurations were found. Type 1, a tendinous slip branched from the FHL to the FDL (62 of 64 feet). Type 2, a slip branched from the FHL to the FDL and another slip from the FDL to FHL (2 of 64). The average length of the FHL graft available from a single incision measured 5.08 cm (range 3.32-10.35, SD = 1.09), double incision technique measured 6.72 cm (range 4.69-12.09, SD = 1.03), and minimally invasive incision measured 17.49 cm (range 13.51-20.52, SD = 1.80). The difference between the lengths obtained from these three techniques was statistically significant (p < 0.001). The absence of no attachment and FDL tendon to the FHL between the two tendons in the foot may be more frequent than previously reported. Only two configurations of the anatomical relationship were found in this study. In over 96 % of the feet, a proximal to distal connection from the FHL to the FDL was found, which might contribute to the residual function of the lesser toes after FDL transfer.

  1. Surface Treatment with 5-Fluorouracil After Flexor Tendon Repair in a Canine in Vivo Model

    PubMed Central

    Zhao, Chunfeng; Zobitz, Mark E.; Sun, Yu-Long; Predmore, Kelly S.; Amadio, Peter C.; An, Kai-Nan; Moran, Steven L.

    2009-01-01

    Background: Topical 5-fluorouracil has been reported to reduce adhesions in animal models of tenolysis. The purpose of this study was to investigate the effects of topical 5-fluorouracil on adhesion formation after tendon repairs were subjected to immediate postoperative rehabilitation in a canine model in vivo. Methods: Sixty dogs were randomly assigned to either a 5-fluorouracil treatment (thirty dogs) or a control group (thirty dogs). Each treatment group was then divided into three survival time points: ten days, twenty-one days, and forty-two days. The second and fifth flexor digitorum profundus tendons from each dog were fully lacerated at the zone-II area and then were repaired. Passive motion therapy started at day 5 postoperatively and continued until the dogs were killed. The repaired tendons were evaluated for normalized work of flexion, gliding resistance, repair strength, gene expression for type-I and type-III collagen and transforming growth factor-β1, and histological appearance. Results: The normalized work of flexion of the repaired tendons treated with 5-fluorouracil was significantly lower than that of the repaired tendons without 5-fluorouracil treatment at ten days. However, there was no significant difference between treated and untreated tendons at twenty-one and forty-two days. There was also no significant difference in gliding resistance, repair failure strength, or stiffness between treated and untreated tendons at any time point, or in the gross or histological appearance of adhesions at the time of killing. The expression of types-I and III collagen and transforming growth factor-β1 of the repaired tendon with 5-fluorouracil treatment was significantly lower than that of the tendons without treatment at ten days postoperatively, but not at twenty-one or forty-two days. Conclusions: Although 5-fluorouracil treatment can reduce adhesions in in vivo models of tenolysis, this treatment had only a transient effect in an in vivo model of

  2. Force Depression in Plantar Flexors Exists Equally in Plantar Flexed and Dorsiflexed Regions

    PubMed Central

    Fukutani, Atsuki; Misaki, Jun; Isaka, Tadao

    2017-01-01

    Isometric muscle force attained during isometric contractions decreases after active shortening compared to that attained during purely isometric contractions. This phenomenon is called residual force depression. The aim of this study was to examine whether residual force depression occurs in human plantar flexors in both plantar flexed and dorsiflexed region. In addition, the magnitude of fascicle shortening was evaluated because not only muscle force but also fascicle shortening during active shortening are considered to affect force depression. Eleven male subjects were recruited. All muscle contractions were evoked by muscle belly-electrical stimulation. In the reference trials, isometric plantar flexion (PF) was performed at 0° and 15° of PF. In the residual force depression trials, the following two contractions were conducted: (1) muscles were activated isometrically at 15° of dorsiflexion, then actively shortened to 0° of PF (long condition) and (2) muscles were activated isometrically at 0° of PF, then actively shortened to 15° of PF (short condition). Isometric joint torque obtained 4.9 s after the onset of contraction was compared between the reference and residual force depression trials at the same joint angle to calculate the magnitude of residual force depression. At the same time point, fascicle length and pennation angle were obtained from ultrasonographic images to examine whether the muscle architecture affected residual force depression. As a result, residual force depression was confirmed in both the long and short length conditions (long: 87.1 ± 9.1%, short: 92.1 ± 7.8%) while the magnitude was not different (p = 0.182). The fascicle length and pennation angle were not different between the reference and residual force depression trials (p = 0.291–0.906). These results indicate that residual force depression occurs in the physiological range of motion in the human plantar flexors, and this phenomenon is not related to muscle

  3. The Artificial Gravity Bed Rest Pilot Project: Effects on Knee Extensor and Plantar Flexor Muscle Groups

    NASA Technical Reports Server (NTRS)

    Caiozzo, V. J.; Haddad, F.; Lee, S.; Baker, M.; Baldwin, K. M.

    2007-01-01

    The goal of this project was to examine the effects of artificial gravity (2.5 g) on skeletal muscle strength and key anabolic/catabolic markers known to regulate muscle mass. Two groups of subjects were selected for study: 1) a 21 day-bed rest (BR) control (C) group (N=7); and 2) an AG group (N=8), which was exposed to 21 days of bed-rest plus daily 1 hr exposures to AG (2.5 g). This particular experiment was part of an integrated AG Pilot Project sponsored by NASA/Johnson Space Center. The in vivo torque-velocity relationships of the knee extensors and plantar flexors of the ankle were determined pre and post treatment. Also, pre- and post treatment biopsy samples were obtained from both the vastus lateralis and soleus muscles and were used, in part, for a series of analyses on gene expression (mRNA abundance) of key factors implicated in the anabolic versus catabolic state of the muscle. Post/Pre toque-velocity determinations revealed greater decrements in knee extensor performance in the C versus AG group (P less than 0.04). The plantar flexor muscle group of the AG subjects actually demonstrated a net gain in torque-velocity relationship; whereas, in the C group the overall post/pre responses declined (AG vs C; P less than 0.001). Measurements of muscle fiber cross-sectional area (for both muscles) demonstrated a loss of approx. 20% in the C group while no losses were evident in the AG group. RT-PCR analyses of muscle biopsy specimens demonstrated that markers of growth and cytoskeletal integrity (IGF-1, IGF-1 BP4, mechano growth factor, total RNA, and pro-collagen 3a) were higher in the AG group, whereas catabolic markers (myostatin and atrogen) were elevated in the C group. Importantly, these patterns were seen in both muscles. Based on these observations we conclude that paradigms of AG have the potential to maintain the functional, biochemical, and structural homeostasis of skeletal muscle in the face of chronic unloading states. These findings also

  4. Focal Experimental Injury Leads to Widespread Gene Expression and Histologic Changes in Equine Flexor Tendons

    PubMed Central

    Jacobsen, Else; Dart, Andrew J.; Mondori, Takamitsu; Horadogoda, Neil; Jeffcott, Leo B.; Little, Christopher B.; Smith, Margaret M.

    2015-01-01

    It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3cm regions) for histologic (scoring and immunohistochemistry) and gene expression (real time PCR) analysis of extracellular matrix changes. The histopathology score was significantly higher in transected tendons compared to control tendons in all regions except for the most distal (P ≤ 0.03) with no differences between overstressed (medial) and stress-deprived (lateral) tendon halves. Proteoglycan scores were increased by transection in all but the most proximal region (P < 0.02), with increased immunostaining for aggrecan, biglycan and versican. After correcting for location within the tendon, gene expression for aggrecan, versican, biglycan, lumican, collagen types I, II and III, MMP14 and TIMP1 was increased in transected tendons compared with control tendons (P < 0.02) and decreased for ADAMTS4, MMP3 and TIMP3 (P < 0.001). Aggrecan, biglycan, fibromodulin, and collagen types I and III expression positively correlated with all histopathology scores (P < 0.001), whereas lumican, ADAMTS4 and MMP14 expression positively correlated only with collagen fiber malalignment (P < 0.001). In summary, histologic and associated gene expression changes were significant and widespread six weeks after injury to the equine SDFT, suggesting rapid and active development of tendinopathy throughout the entire length of the tendon. These extensive changes distant to the focal injury may contribute to poor functional outcomes and re

  5. Focal experimental injury leads to widespread gene expression and histologic changes in equine flexor tendons.

    PubMed

    Jacobson, Else; Jacobsen, Else; Dart, Andrew J; Mondori, Takamitsu; Horadogoda, Neil; Jeffcott, Leo B; Little, Christopher B; Smith, Margaret M

    2015-01-01

    It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3 cm regions) for histologic (scoring and immunohistochemistry) and gene expression (real time PCR) analysis of extracellular matrix changes. The histopathology score was significantly higher in transected tendons compared to control tendons in all regions except for the most distal (P ≤ 0.03) with no differences between overstressed (medial) and stress-deprived (lateral) tendon halves. Proteoglycan scores were increased by transection in all but the most proximal region (P < 0.02), with increased immunostaining for aggrecan, biglycan and versican. After correcting for location within the tendon, gene expression for aggrecan, versican, biglycan, lumican, collagen types I, II and III, MMP14 and TIMP1 was increased in transected tendons compared with control tendons (P < 0.02) and decreased for ADAMTS4, MMP3 and TIMP3 (P < 0.001). Aggrecan, biglycan, fibromodulin, and collagen types I and III expression positively correlated with all histopathology scores (P < 0.001), whereas lumican, ADAMTS4 and MMP14 expression positively correlated only with collagen fiber malalignment (P < 0.001). In summary, histologic and associated gene expression changes were significant and widespread six weeks after injury to the equine SDFT, suggesting rapid and active development of tendinopathy throughout the entire length of the tendon. These extensive changes distant to the focal injury may contribute to poor functional outcomes and re

  6. Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings.

    PubMed

    Opar, David A; Williams, Morgan D; Timmins, Ryan G; Dear, Nuala M; Shield, Anthony J

    2013-06-01

    The aim of this study was to determine if athletes with a history of hamstring strain injury display lower levels of surface EMG (sEMG) activity and median power frequency in the previously injured hamstring muscle during maximal voluntary contractions. Recreational athletes were recruited, 13 with a history of unilateral hamstring strain injury and 15 without prior injury. All athletes undertook isokinetic dynamometry testing of the knee flexors and sEMG assessment of the biceps femoris long head (BF) and medial hamstrings (MHs) during concentric and eccentric contractions at ±180 and ±60°s(-1). The knee flexors on the previously injured limb were weaker at all contraction speeds compared to the uninjured limb (+180°s(-1)p=0.0036; +60°s(-1)p=0.0013; -60°s(-1)p=0.0007; -180°s(-1)p=0.0007) whilst sEMG activity was only lower in the BF during eccentric contractions (-60°s(-1)p=0.0025; -180°s(-1)p=0.0003). There were no between limb differences in MH sEMG activity or median power frequency from either BF or MH in the injured group. The uninjured group showed no between limb differences in any of the tested variables. Secondary analysis comparing the between limb difference in the injured and the uninjured groups, confirmed that previously injured hamstrings were mostly weaker (+180°s(-1)p=0.2208; +60°s(-1)p=0.0379; -60°(-1)p=0.0312; -180°s(-1)p=0.0110) and that deficits in sEMG were confined to the BF during eccentric contractions (-60°s(-1)p=0.0542; -180°s(-1)p=0.0473). Previously injured hamstrings were weaker and BF sEMG activity was lower than the contralateral uninjured hamstring. This has implications for hamstring strain injury prevention and rehabilitation which should consider altered neural function following hamstring strain injury. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. The Artificial Gravity Bed Rest Pilot Project: Effects on Knee Extensor and Plantar Flexor Muscle Groups

    NASA Technical Reports Server (NTRS)

    Caiozzo, V. J.; Haddad, F.; Lee, S.; Baker, M.; Baldwin, K. M.

    2007-01-01

    The goal of this project was to examine the effects of artificial gravity (2.5 g) on skeletal muscle strength and key anabolic/catabolic markers known to regulate muscle mass. Two groups of subjects were selected for study: 1) a 21 day-bed rest (BR) control (C) group (N=7); and 2) an AG group (N=8), which was exposed to 21 days of bed-rest plus daily 1 hr exposures to AG (2.5 g). This particular experiment was part of an integrated AG Pilot Project sponsored by NASA/Johnson Space Center. The in vivo torque-velocity relationships of the knee extensors and plantar flexors of the ankle were determined pre and post treatment. Also, pre- and post treatment biopsy samples were obtained from both the vastus lateralis and soleus muscles and were used, in part, for a series of analyses on gene expression (mRNA abundance) of key factors implicated in the anabolic versus catabolic state of the muscle. Post/Pre toque-velocity determinations revealed greater decrements in knee extensor performance in the C versus AG group (P less than 0.04). The plantar flexor muscle group of the AG subjects actually demonstrated a net gain in torque-velocity relationship; whereas, in the C group the overall post/pre responses declined (AG vs C; P less than 0.001). Measurements of muscle fiber cross-sectional area (for both muscles) demonstrated a loss of approx. 20% in the C group while no losses were evident in the AG group. RT-PCR analyses of muscle biopsy specimens demonstrated that markers of growth and cytoskeletal integrity (IGF-1, IGF-1 BP4, mechano growth factor, total RNA, and pro-collagen 3a) were higher in the AG group, whereas catabolic markers (myostatin and atrogen) were elevated in the C group. Importantly, these patterns were seen in both muscles. Based on these observations we conclude that paradigms of AG have the potential to maintain the functional, biochemical, and structural homeostasis of skeletal muscle in the face of chronic unloading states. These findings also

  8. Plantar flexor muscle weakness and fatigue in spastic cerebral palsy patients.

    PubMed

    Neyroud, Daria; Armand, Stéphane; De Coulon, Geraldo; Sarah R Dias Da Silva; Maffiuletti, Nicola A; Kayser, Bengt; Place, Nicolas

    2017-02-01

    Patients with cerebral palsy develop an important muscle weakness which might affect the aetiology and extent of exercise-induced neuromuscular fatigue. This study evaluated the aetiology and extent of plantar flexor neuromuscular fatigue in patients with cerebral palsy. Ten patients with cerebral palsy and 10 age- and sex-matched healthy individuals (∼20 years old, 6 females) performed four 30-s maximal isometric plantar flexions interspaced by a resting period of 2-3s to elicit a resting twitch. Maximal voluntary contraction force, voluntary activation level and peak twitch were quantified before and immediately after the fatiguing task. Before fatigue, patients with cerebral palsy were weaker than healthy individuals (341±134N vs. 858±151N, p<0.05) and presented lower voluntary activation (73±19% vs. 90±9%, p<0.05) and peak twitch (100±28N vs. 199±33N, p<0.05). Maximal voluntary contraction force was not significantly reduced in patients with cerebral palsy following the fatiguing task (-10±23%, p>0.05), whereas it decreased by 30±12% (p<0.05) in healthy individuals. Plantar flexor muscles of patients with cerebral palsy were weaker than their healthy peers but showed greater fatigue resistance. Cerebral palsy is a widely defined pathology that is known to result in muscle weakness. The extent and origin of muscle weakness were the topic of several previous investigations; however some discrepant results were reported in the literature regarding how it might affect the development of exercise-induced neuromuscular fatigue. Importantly, most of the studies interested in the assessment of fatigue in patients with cerebral palsy did so with general questionnaires and reported increased levels of fatigue. Yet, exercise-induced neuromuscular fatigue was quantified in just a few studies and it was found that young patients with cerebral palsy might be more fatigue resistant that their peers. Thus, it appears that (i) conflicting results exist regarding

  9. Epimuscular myofascial force transmission occurs in the rat between the deep flexor muscles and their antagonistic muscles.

    PubMed

    Yucesoy, Can A; Baan, Guus; Huijing, Peter A

    2010-02-01

    The goal of the present study was to test the hypothesis that epimuscular myofascial force transmission occurs between deep flexor muscles of the rat and their antagonists: previously unstudied mechanical effects of length changes of deep flexors on the anterior crural muscles (i.e., extensor digitorum longus (EDL), as well as tibialis anterior and extensor hallucis longus muscle complex (TA+EHL) and peroneal (PER) muscles were assessed experimentally. These muscles or muscle groups were kept at constant length, whereas, distal length changes were imposed on deep flexor (DF) muscles before performing isometric contractions. Distal forces of all muscle-tendon complexes were measured simultaneously, in addition to EDL proximal force. Distal lengthening of DF caused substantial significant effects on its antagonistic muscles: (1) increase in proximal EDL total force (maximally 19.2%), (2) decrease in distal EDL total (maximally 8.4%) and passive (maximally 49%) forces, (3) variable proximo-distal total force differences indicating net proximally directed epimuscular myofascial loads acting on EDL at lower DF lengths and net distally directed loads at higher DF lengths, (4) decrease in TA+EHL total (maximally 50%) and passive (maximally 66.5%) forces and (5) decrease in PER total force (maximally 51.3%). It is concluded that substantial inter-antagonistic epimuscular myofascial force transmission occurs between deep flexor, anterior crural and peroneal muscles. In the light of our present results and recently reported evidence on inter-antagonistic interaction between anterior crural, peroneal and triceps surae muscles, we concluded that epimuscular myofascial force transmission is capable of causing major effects within the entire lower leg of the rat. Implications of such large scale myofascial force transmission are discussed and expected to be crucial to muscle function in healthy, as well as pathological conditions.

  10. The Effects of Bio-Lubricating Molecules on Flexor Tendon Reconstruction in A Canine Allograft Model In Vivo

    PubMed Central

    Zhao, Chunfeng; Wei, Zhuang; Kirk, Ramona L.; Thoreson, Andrew R.; Jay, Gregory D.; Moran, Steven L.; An, Kai-Nan; Amadio, Peter C.

    2014-01-01

    Background Using allograft is an attractive alternative for flexor tendon reconstruction because of the lack of donor morbidity, and better matching to the intrasynovial environment. The purpose of this study was to use biolubricant molecules to modify the graft surface to decrease adhesions and improve digit function. Methods 28 flexor digitorum profundus (FDP) tendons from the 2nd and 5th digits of 14 dogs were first lacerated and repaired to create a model with repair failure and scar digit for tendon reconstruction. Six weeks after the initial surgery, the tendons were reconstructed with FDP allograft tendons obtained from canine cadavers. One graft tendon in each dog was treated with saline as a control and the other was treated with gelatin, carbodiimide derivatized, hyaluronic acid and lubricin (cd-HA-Lubricin). Six weeks postoperatively, digit function, graft mechanics, and biology were analyzed. Results Allograft tendons treated with cd-HA-Lubricin had decreased adhesions at the proximal tendon/graft repair and within flexor sheath, improved digit function, and increased graft gliding ability. The treatment also reduced the strength at the distal tendon to bone repair, but the distal attachment rupture rate was similar for both graft types. Histology showed that viable cells migrated to the allograft, but these were limited to the tendon surface. Conclusion cd-HA-Lubricin treatment of tendon allograft improves digit functional outcomes after flexor tendon reconstruction. However, delayed bone-tendon healing should be a caution. Furthermore, the cell infiltration into the allograft tendons substance should be a target for future studies, to shorten the allograft self-regeneration period. PMID:24445876

  11. Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits.

    PubMed

    Duci, Shkelzen B; Arifi, Hysni M; Ahmeti, Hasan R; Manxhuka-Kerliu, Suzana; Neziri, Burim; Mekaj, Agon Y; Lajqi, Shpetim; Shahini, Labinot

    2015-06-20

    The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU) on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs]) following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and biomechanical evaluations of tendon adhesions. We used 32 adult male European rabbits (Oryctolagus cunniculus) weighing from 2.5 to 3.5 kg. The study was performed on the deep flexor tendons of the second and third digits of the right hind paws of the rabbits; thus, a total of 64 tendons were examined in this study. Based on the results achieved in our experimental study, the load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared with subgroup 2a in which tendons were surgically repaired and treated with 5-FU. The load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared to subgroup 2a in which the tendons were surgically repaired and treated with 5-FU. Therefore, these results revealed a decrease in adhesion formation in the subgroup that was treated with 5-FU due to increased resistance to tendon adhesions during their excursion through the tendon sheath, which in this case required greater traction force.

  12. Effect of Transcutaneous Electrical Nerve Stimulation on Plantar Flexor Muscle Spasticity and Walking Speed in Stroke Patients.

    PubMed

    Laddha, Darshan; Ganesh, G Shankar; Pattnaik, Monalisa; Mohanty, Patitapaban; Mishra, Chittaranjan

    2016-12-01

    Spasticity is a major disabling symptom in patients post stroke. Although studies have demonstrated that transcutaneous electrical nerve stimulation (TENS) can reduce spasticity, the duration of single session TENS is a subject of debate. The purpose of this study was to determine the sustainability of the effects of TENS applied over common peroneal nerve in the reduction of ankle plantar-flexor spasticity and improving gait speed in patients post stroke. Thirty patients (11 women and 19 men) (mean age of 46.46 years) were randomly assigned to group 1 (task oriented exercises), group 2 (TENS for 30 min and task oriented exercises) and group 3 (TENS for 60 min and task oriented exercises) for a period of five sessions per week for 6 weeks. All patients were assessed for ankle plantar-flexor spasticity, passive ankle dorsi-flexion range of motion, clonus and timed up and go test at the time of recruitment to study, at 3 and 6 weeks of therapeutic intervention. The overall results of the study suggest that there was a decrease in ankle plantar flexor spasticity, ankle clonus and timed up and go score in all the groups. A greater reduction of spasticity was seen in TENS groups (groups 2 and 3) when compared to control. No significant improvement was found in timed up and go test (TUG) scores between groups. Both 30 min and 60 min of application of TENS are effective in reducing spasticity of ankle plantar flexors, improving walking ability and increase the effectiveness of task related training. Based on the effect size, we would recommend a longer duration application for the reduction of spasticity. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  13. Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits

    PubMed Central

    Duci, Shkelzen B; Arifi, Hysni M; Ahmeti, Hasan R; Manxhuka-Kerliu, Suzana; Neziri, Burim; Mekaj, Agon Y; Lajqi, Shpetim; Shahini, Labinot

    2015-01-01

    Background: The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU) on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs]) following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and biomechanical evaluations of tendon adhesions. Methods: We used 32 adult male European rabbits (Oryctolagus cunniculus) weighing from 2.5 to 3.5 kg. The study was performed on the deep flexor tendons of the second and third digits of the right hind paws of the rabbits; thus, a total of 64 tendons were examined in this study. Results: Based on the results achieved in our experimental study, the load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared with subgroup 2a in which tendons were surgically repaired and treated with 5-FU. Conclusions: The load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared to subgroup 2a in which the tendons were surgically repaired and treated with 5-FU. Therefore, these results revealed a decrease in adhesion formation in the subgroup that was treated with 5-FU due to increased resistance to tendon adhesions during their excursion through the tendon sheath, which in this case required greater traction force. PMID:26063369

  14. Minimally invasive flexor hallucis longus transfer in management of acute achilles tendon rupture associated with tendinosis: a case report.

    PubMed

    Lui, Tun Hing

    2012-04-01

    Chronic tendinopathy is characterized by pain in the tendon, generally at the start and completion of exercise. However, tendinosis may lead to decreased blood flow, increased stiffness of the tendon and reduced tensile strength, and predispose to rupture. Operative treatment is indicated to restore the function of the Achilles tendon and alleviate the prerupture heel cord pain. A case of acute Achilles tendon rupture with extensive tendinosis that was successfully treated with minimally invasive flexor hallucis longus transfer is reported.

  15. The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe

    PubMed Central

    2013-01-01

    Background Flexor tenotomy is a minimally invasive surgical alternative for the treatment of neuropathic diabetic foot ulcers on the distal end of the toe. The influence of infection on healing and time to heal after flexor tenotomy is unknown. Flexor tenotomy can also be used as a prophylactic treatment. The effectiveness as a prophylactic treatment has not been described before. Methods A retrospective study was performed with the inclusion of all consecutive flexor tenotomies from one hospital between January 2005 and December 2011. Results From 38 ulcers, 35 healed (92%), with a mean time to heal of 22 ± 26 days. The longest duration for healing was found for infected ulcers that were penetrating to bone (35 days; p = .042). Cases of prophylactic flexor tenotomies (n=9) did not result in any ulcer or other complications during follow-up. Conclusions The results of this study suggest that flexor tenotomy may be beneficial for neuropathic diabetic foot ulcers on the distal end of the toe, with a high healing percentage and a short mean time to heal. Infected ulcers that penetrated to bone took a significantly longer time to heal. Prospective research, to confirm the results of this retrospective study, should be performed. PMID:23347589

  16. Plantar-flexor Static Stretch Training Effect on Eccentric and Concentric Peak Torque – A comparative Study of Trained versus Untrained Subjects

    PubMed Central

    Abdel-aziem, Amr Almaz; Mohammad, Walaa Sayed

    2012-01-01

    The aim of this study was to examine the long-term effects of static stretching of the plantar-flexor muscles on eccentric and concentric torque and ankle dorsiflexion range of motion in healthy subjects. Seventy five healthy male volunteers, with no previous history of trauma to the calf that required surgery, absence of knee flexion contracture and no history of neurologic dysfunction or disease, systemic disease affecting the lower extremities were selected for this study. The participants were divided into three equal groups. The control group did not stretch the plantar-flexor muscles. Two Experimental groups (trained and untrained) were instructed to perform static stretching exercise of 30 second duration and 5 repetitions twice daily. The stretching sessions were carried out 5 days a week for 6 weeks. The dorsiflexion range of motion was measured in all subjects. Also measured was the eccentric and concentric torque of plantar-flexors at angular velocities of 30 and 120°/s pre and post stretching. Analysis of variance showed a significant increase in plantar-flexor eccentric and concentric torque (p < 0.05) of trained and untrained groups, and an increase in dorsiflexion range of motion (p < 0.05) at both angular velocities for the untrained group only. The static stretching program of plantar-flexors was effective in increasing the concentric and eccentric plantarflexion torque at angular velocities of 30 and 120°/s. Increases in plantar-flexors flexibility were observed in untrained subjects. PMID:23486840

  17. Sensitivity of the NeuroFlexor method to measure change in spasticity after treatment with botulinum toxin A in wrist and finger muscles.

    PubMed

    Gäverth, Johan; Eliasson, Ann-Christin; Kullander, Kjell; Borg, Jörgen; Lindberg, Påvel G; Forssberg, Hans

    2014-07-01

    The NeuroFlexor objectively quantifies the neural, elastic and viscous components of passive movement resistance in wrist and finger flexor muscles. In this study we investigated the sensitivity of the NeuroFlexor to changes in spasticity induced by treatment with botulinum toxin type A (BoNT-A). Prospective observational design. A convenience sample of 22 adults with post-stroke upper limb spasticity scheduled for botulinum toxin treatment. BoNT-A was given according to individual treatment plans. NeuroFlexor assessments were made before treatment and 4 and 12 weeks after. At group level, spasticity decreased significantly at 4 weeks (expected time of maximum effect) (p = 0.04). At 12 weeks, spasticity had rebounded and no longer differed significantly from baseline (p = 0.64), i.e. in line with the pharmacodynamics of BoNT-A. At the individual level, 7 participants showed a reduction in spasticity greater than the measurement error. The reduction was dose-dependent (r(20) = 0.66, p < 0.001), and largest in participants with the highest dose. At the group level, the sensitivity of NeuroFlexor is good enough to detect reduction in spasticity after treatment with BoNT-A. Further work is needed to establish the sensitivity of NeuroFlexor on an individual level.

  18. A novel classification of musculocutaneous nerve variations: The relationship between the communicating branch and transposed innervation of the brachial flexors to the median nerve.

    PubMed

    Hayashi, Mari; Shionoya, Kento; Hayashi, Shogo; Hatayama, Naoyuki; Kawata, Shinichi; Qu, Ning; Hirai, Shuichi; Miyaso, Hidenobu; Itoh, Masahiro

    2017-01-01

    The musculocutaneous nerve innervates the brachial flexors; i.e., the coracobrachialis, biceps brachii, and brachialis. The musculocutaneous and median nerve sometimes share a communicating branch and also muscular branches to brachial flexors are sometimes transposed to median nerve. Because these variations constitute a potentially important clinical and surgical issue, we evaluated 130 upper limbs of 65 cadavers and 184 cases of musculocutaneous and median nerve variations in the literature and devised a novel system of classification that covers each pattern of variation. Our proposed classification was applicable in all of our cases and those previously reported. In addition, transposed innervation of the brachial flexors from the musculocutaneous nerve to the communicating branches was observed in one limb in our case series. In this case and all previously reported cases of transposed innervation of the brachial flexors, communicating branches between the musculocutaneous and median nerve were found and no brachial flexor branch arose from the musculocutaneous nerve distal to the communicating branches. Consequently, we established that, as per our novel classification, all patterns of communicating branches could be classified into five types and the patterns of transposed innervation of the brachial flexors into three types. Copyright © 2016 Elsevier GmbH. All rights reserved.

  19. Deep cervical flexor training with a pressure biofeedback unit is an effective method for maintaining neck mobility and muscular endurance in college students with forward head posture.

    PubMed

    Kang, Dong Yeon

    2015-10-01

    [Purpose] This study investigated the effects of deep cervical flexor training on maintaining forward head posture, muscular endurance, and cervical mobility. It also examined the effectiveness of deep cervical flexor training with a pressure biofeedback unit. [Subjects and Methods] Twenty college students were recruited and randomly assigned to groups that underwent either deep cervical flexor training with a pressure biofeedback unit (experimental group, n=10) or conventional deep cervical flexor training (control group, n=10). The craniovertebral angle of each subject was measured with a lateral-view picture. Neck mobility was assessed using a cervical range of motion device and muscular endurance was measured using a pressure biofeedback unit. Both groups performed conventional deep cervical flexor exercises three times a week for six weeks. The experimental group underwent a pressure biofeedback unit training was 5 to10 minutes/day, thrice a week. [Results] Cervical range of motion in the experimental group increased significantly between the end of training and the end of the four week detraining period, compared to that in control group. [Conclusion] Deep cervical flexor training with a pressure biofeedback unit is a useful method for maintaining neck mobility and muscular endurance in people with forward head posture.

  20. Plantar-flexor Static Stretch Training Effect on Eccentric and Concentric Peak Torque - A comparative Study of Trained versus Untrained Subjects.

    PubMed

    Abdel-Aziem, Amr Almaz; Mohammad, Walaa Sayed

    2012-10-01

    The aim of this study was to examine the long-term effects of static stretching of the plantar-flexor muscles on eccentric and concentric torque and ankle dorsiflexion range of motion in healthy subjects. Seventy five healthy male volunteers, with no previous history of trauma to the calf that required surgery, absence of knee flexion contracture and no history of neurologic dysfunction or disease, systemic disease affecting the lower extremities were selected for this study. The participants were divided into three equal groups. The control group did not stretch the plantar-flexor muscles. Two Experimental groups (trained and untrained) were instructed to perform static stretching exercise of 30 second duration and 5 repetitions twice daily. The stretching sessions were carried out 5 days a week for 6 weeks. The dorsiflexion range of motion was measured in all subjects. Also measured was the eccentric and concentric torque of plantar-flexors at angular velocities of 30 and 120°/s pre and post stretching. Analysis of variance showed a significant increase in plantar-flexor eccentric and concentric torque (p < 0.05) of trained and untrained groups, and an increase in dorsiflexion range of motion (p < 0.05) at both angular velocities for the untrained group only. The static stretching program of plantar-flexors was effective in increasing the concentric and eccentric plantarflexion torque at angular velocities of 30 and 120°/s. Increases in plantar-flexors flexibility were observed in untrained subjects.

  1. Work and power of the knee flexor and extensor muscles in patients with osteoarthritis and after total knee arthroplasty.

    PubMed

    Bastiani, Denise; Ritzel, Cintia Helena; Bortoluzzi, Silvia Manfrin; Vaz, Marco Aurelio

    2012-01-01

    The inflammatory manifestations of knee osteoarthritis (OA) lead to muscle inhibition and hypotrophy, resulting in a reduction in total muscle work and muscle power. Total knee arthroplasty (TKA) is the most adequate surgery for the treatment of advanced OA. However, its effects on muscle functional behavior have not been well understood. To compare the total work and power of the knee flexor and extensor muscles in patients with OA (20) and in patients post-TKA (12) at two angular velocities (60º/sec and 240º/sec). An isokinetic Biodex dynamometer was used to assess muscle power and total work during isokinetic contractions. Two-way ANOVA for repeated measures was used to compare total muscle work and muscle power between the groups (SPSS software, version 13.0; significance level, P < 0.05). There was no difference between the OA and TKA groups for the total work of both knee extensors and flexors at the two angular velocities (P > 0.05). In addition, no difference was observed in the muscle power of the knee extensors and flexors (P > 0.05). Total work and power were similar in the OA and TKA groups, suggesting that TKA did not improve functional capacity, which was similar in both groups.

  2. [Acute myofascial low back pain as a consequence of functional disorganization between flexors and extensors of the body].

    PubMed

    Stefanidi, A V; Skoromets, A A; Dukhovnikova, I M

    2009-01-01

    The acute low back pain is considered as a consequence of the disorganization between flexors and extensors of the body emerged as a result of wrong afferent stimulation. In definite conditions, when muscle proprioceptors send the contradictory information to the CNS, there is a possibility of the simultaneous reduction of both muscles-agonists and muscles-antagonists which can lead to the reduction of flexors of the body during lumbar extension. The authors suggest a method of treatment of acute pain syndrome in the lower part of the back by the manual relaxation of flexors of the body (muscle (m) rectus, m. obliquus abdominis, m. iliopsoas). Using this method, 119 patients with pain syndrome in the lumbar-sacral part (without symptoms of failure of function of spinal roots) first occurred less than a month ago were treated. After three sessions, the pain in the lower part of the back completely vanished in more than a third of patients (38%), significantly decreased in 48% and remained unchanged only in 14% of cases.

  3. Comparison of elasticity of human tendon and aponeurosis in knee extensors and ankle plantar flexors in vivo.

    PubMed

    Kubo, Keitaro; Kanehisa, Hiroaki; Fukunaga, Tetsuo

    2005-05-01

    The purposes of this study were to compare the elasticity of tendon and aponeurosis in human knee extensors and ankle plantar flexors in vivo and to examine whether the maximal strain of tendon was correlated to that of aponeurosis. The elongation of tendon and aponeurosis during isometric knee extension (n = 23) and ankle plantar flexion (n = 22), respectively, were determined using a real-time ultrasonic apparatus, while the participants performed ramp isometric contractions up to voluntary maximum. To calculate the strain values from the measured elongation, we measured the respective length of tendon and aponeurosis. For the knee extensors, the maximal strain of aponeurosis (12.1 +/- 2.8 %) was significantly greater than that of the patella tendon (8.3 +/- 2.4 %), p < 0.001. On the contrary, the maximal strain of Achilles tendon (5.9 +/- 1.4 %) was significantly greater than that of aponeurosis in ankle plantar flexors (2.7 +/- 1.4 %), p < 0.001. Furthermore, for both knee extensors and ankle plantar flexors there was no significant correlation between maximal strain of tendon and aponeurosis. These results would be important for understanding the different roles of tendon and aponeurosis during human movements and for more accurate muscle modeling.

  4. Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer.

    PubMed

    Muff, Guillaume; Dufour, Stéphane; Meyer, Alain; Severac, François; Favret, Fabrice; Geny, Bernard; Lecocq, Jehan; Isner-Horobeti, Marie-Eve

    2016-09-01

    [Purpose] To compare measurements of knee extensor and flexor muscle strength performed using a hand-held dynamometer and an isokinetic dynamometer in apparently healthy subjects. [Subjects and Methods] Thirty adult volunteers underwent knee muscle strength evaluation using an isokinetic or a hand-held dynamometer. [Results] Strong positive correlations were found between the 2 methods, with correlation coefficients r ranging from 0.72 (95% confidence interval [CI], 0.48-0.86) to 0.87 (95% CI, 0.75-0.94), depending on the muscle group and the isokinetic evaluation mode. The reproducibility of the hand-held dynamometer findings was good, judged by a coefficient of variation of 3.2-4.2%. However, the correlation between the 2 methods for the assessment of flexor/extensor ratios ranged from -0.04 to 0.46. [Conclusion] Knee extensor and flexor muscle strength recorded with a hand-held dynamometer is reproducible and significantly correlated with the isokinetic values, indicating that this method may in some cases be a useful replacement for isokinetic strength measurement. However, for strength ratio assessment, and when judged against the isokinetic standard, a hand-held dynamometer is not a valid option.

  5. Effects of eccentric exercise on optimum length of the knee flexors and extensors during the preseason in professional soccer players.

    PubMed

    Brughelli, Matt; Mendiguchia, Jurdan; Nosaka, Ken; Idoate, Fernando; Arcos, Asier Los; Cronin, John

    2010-05-01

    To assess the effects of eccentric exercise on optimum lengths of the knee flexors and extensors during the preseason in professional soccer. Twenty-eight athletes from a professional Spanish soccer team (Division II) were randomly assigned to an eccentric exercise intervention group (EG) or a control group (CG). Over the four-week period two athletes from the control group suffered RF injuries and two athletes were contracted by other clubs. After these exclusions, both groups (EG, n=13; and CG, n=11) performed regular soccer training during the four-week preseason period. After the four weeks, the optimum lengths of the knee flexors were significantly (P<0.05) increased by 2.3 degrees in the CG and by 4.0 degrees in the EG. The change in the EG was significantly (P<0.05) greater than that of the CG. The optimum lengths of the knee extensors were significantly increased only in the EG by 6.5 degrees . Peak torque levels and ratios of quadriceps to hamstring (Q/H ratios) were not significantly altered throughout the study for either group. Eccentric exercise can increase the optimum lengths of both the knee extensors and knee extensors flexors during the preseason in professional soccer.

  6. The relationship between cervical flexor endurance, cervical extensor endurance, VAS, and disability in subjects with neck pain

    PubMed Central

    2014-01-01

    Background Several tests have been suggested to assess the isometric endurance of the cervical flexor (NFME) and extensors (NEE) muscles. This study proposes to determine whether neck flexors endurance is related to extensor endurance, and whether cervical muscle endurance is related to disability, pain amount and pain stage in subjects with neck pain. Methods Thirty subjects (18 women, 12 men, mean ± SD age: 43 ± 12 years) complaining of neck pain filled out the Visual Analogue Scale (VAS) and the Neck Pain and Disability Scale-Italian version (NPDS-I). They also completed the timed endurance tests for the cervical muscles. Results The mean endurance was 246.7 ± 150 seconds for the NEE test, and 44.9 ± 25.3 seconds for the NMFE test. A significant correlation was found between the results of these two tests (r = 0.52, p = 0.003). A positive relationship was also found between VAS and NPDS-I (r = 0.549, p = 0.002). The endurance rates were similar for acute/subacute and chronic subjects, whereas males demonstrated significantly higher values compared to females in NFME test. Conclusions These findings suggest that neck flexors and extensors endurance are correlated and that the cervical endurance is not significantly altered by the duration of symptoms in subjects with neck pain. PMID:24581272

  7. The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain.

    PubMed

    Javanshir, Khodabakhsh; Amiri, Mohsen; Mohseni Bandpei, Mohammad Ali; De las Penas, Cesar Fernandez; Rezasoltani, Asghar

    2015-01-01

    The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain is yet to be demonstrated. The purpose of this study was to assess the effect of two exercise programs; craniocervical flexion (CCF) and cervical flexion (CF), on flexor muscles dimensions in patients with chronic neck pain. Following ethical approval, 60 patients were randomly assigned into either a CCF group or a CF group. Patients in the CCF group were given CCF exercises and those in the CF group received CF exercises. All patients received interventions for a period of ten weeks. Pain intensity and functional disability were assessed using numerical pain rate scale and neck disability index, respectively. Dimensions of longus colli (LC) and sternoclidomastoid (SCM) muscles were measured using ultrasonography (US). All measurements were taken before and after interventions. Following intervention, the CCF group demonstrated a significant increase in LC muscle dimensions including cross sectional area, width and thickness compared with the CF group. A statistically significant increase was found on SCM thickness in the CF group. Following intervention, SCM thickness measurement in the CCF group showed no significant changes. Statistically significant decrease on pain intensity and disability were also found in both groups. Present findings demonstrated that craniocervical flexion program which specifically recruiting deep cervical flexor muscles increased LC muscle dimension significantly and CF program as an endurance training program increased SCM thickness.

  8. Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer

    PubMed Central

    Muff, Guillaume; Dufour, Stéphane; Meyer, Alain; Severac, François; Favret, Fabrice; Geny, Bernard; Lecocq, Jehan; Isner-Horobeti, Marie-Eve

    2016-01-01

    [Purpose] To compare measurements of knee extensor and flexor muscle strength performed using a hand-held dynamometer and an isokinetic dynamometer in apparently healthy subjects. [Subjects and Methods] Thirty adult volunteers underwent knee muscle strength evaluation using an isokinetic or a hand-held dynamometer. [Results] Strong positive correlations were found between the 2 methods, with correlation coefficients r ranging from 0.72 (95% confidence interval [CI], 0.48−0.86) to 0.87 (95% CI, 0.75−0.94), depending on the muscle group and the isokinetic evaluation mode. The reproducibility of the hand-held dynamometer findings was good, judged by a coefficient of variation of 3.2–4.2%. However, the correlation between the 2 methods for the assessment of flexor/extensor ratios ranged from −0.04 to 0.46. [Conclusion] Knee extensor and flexor muscle strength recorded with a hand-held dynamometer is reproducible and significantly correlated with the isokinetic values, indicating that this method may in some cases be a useful replacement for isokinetic strength measurement. However, for strength ratio assessment, and when judged against the isokinetic standard, a hand-held dynamometer is not a valid option. PMID:27799667

  9. The Effects of Elbow Joint Angle Change on the Elbow Flexor Muscle Activation in Pulley with Weight Exercise

    PubMed Central

    Kang, Taewook; Seo, Youngjoon; Park, Jaehoon; Dong, Eunseok; Seo, Byungdo; Han, Dongwook

    2013-01-01

    [Purpose] This research investigated the effect of angular variation of flexion of the elbow joint on the muscle activation of elbow flexor muscles. [Subjects] The research subjects were 24 male college students with a dominant right hand who had no surgical or neurological disorders and gave their prior written consent to participation with full knowledge of the method and purpose of this study. [Methods] The subjects' shoulder joints stayed in the resting position, and the elbow joint was positioned at angles of 55°, 70°, and 90°. The angle between the pulley with weights and forearm stayed at 90°. Surface electromyography was used to measure muscle activities. Three measurements were made at each elbow angle, and every time the angle changed, two minutes rest was given. [Result] The muscle activities of the elbow flexors showed significant changes with change in the elbow joint angle, except for the biceps brachii activities between the angles of 55° and 70° of elbow flexion. The muscle activities of the biceps brachii and brachioradialis showed angle-related changes in the order of 55°, which showed the biggest value, followed by 70° and 90°. [Conclusion] In order to improve muscle strength of the elbow flexor using a pulley system, it seems more effective to have a 90° angle between the pulley with weights and the forearm when the muscle is stretched to a length 20% greater than its resting position. PMID:24259930

  10. Correlation between deep cervical flexor muscle thickness at rest and sternocleidomastoid activity during the craniocervical flexion test.

    PubMed

    Ishida, Hiroshi; Suehiro, Tadanobu; Ono, Koji; Kurozumi, Chiharu; Watanabe, Susumu

    2016-01-01

    The purpose of this study was to clarify the relationship between the thickness of the deep cervical flexor muscles (longus capitis and longus colli) at rest and sternocleidomastoid activity during the craniocervical flexion test (CCFT). Thirteen healthy males participated in this study. The thickness of the deep cervical flexor muscles was measured by ultrasound imaging in a relaxed supine position. Activity of the sternocleidomastoid was measured by electromyography during the CCFT at five incremental levels (22, 24, 26, 28, and 30 mm Hg). Correlations between normalized muscle thickness relative to body mass index and sternocleidomastoid activity were determined. Significant negative correlations were observed between normalized muscle thickness and activity of the sternocleidomastoid at 26 (r = -0.622, P = 0.023) and 28 mmHg (r = -0.653, P = 0.015). Individuals with smaller deep cervical flexor muscles exhibited increased activity in the sternocleidomastoid during the CCFT.

  11. Reconstruction of medial collateral ligament defects with a flexor-pronator fascia patch in complete open release of stiff elbows.

    PubMed

    Chen, Shuai; Yan, Hede; Wang, Wei; Zhang, Mei; Hildebrand, Kevin A; Fan, Cun-Yi

    2017-01-01

    Because medial elbow stability is essential for stiff elbow release, surgical techniques have been reported for reconstructing medial elbow stability. However, medial collateral ligament (MCL) defects, caused by inevitable detachment and resection performed for complete release, make the reconstruction more challenging. To our knowledge, no study has evaluated the outcomes after using a flexor-pronator fascia patch in medial elbow reconstruction for open release of stiff elbows. We hypothesized that this technique is effective for repairing MCL defects. We retrospectively reviewed the records of 10 patients. The MCL defects were all reconstructed with a flexor-pronator fascia patch. An external fixator was used in all patients. One patient could not be contacted and was thus excluded from the study. Outcome measures included stability, range of motion, Mayo Elbow Performance Score, ulnar nerve symptoms, power grip, and radiographic findings. The mean follow-up period was 19.6 months; all elbows were stable by the last follow-up. One patient presented with moderate elbow instability and then regained stability 3 months after the external fixator was removed. The Mayo Elbow Performance Score improved from 58 points to 94 points, and the mean flexion arc improved from 40° to 133°. No radiographic manifestations of elbow dislocation or suture anchor looseness were observed. A flexor-pronator fascia patch provides sufficient stability for repairing MCL defects without restricting the range of motion gained during arthrolysis. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

  12. Tendon palpation during agonist contraction and antagonist co-contraction to assess wrist flexor and extensor muscle function.

    PubMed

    Bertelli, J A

    2015-04-01

    The aim of this study was to validate direct tendon palpation during agonist contraction and antagonist co-contraction as a method to assess wrist flexor and extensor muscle function in cases of upper limb paralysis. On one occasion, five doctors examined 17 patients with partial paralysis of the upper limb resulting from brachial plexus or cervical spinal cord injury. We asked examiners to determine if the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU) and palmaris longus (PL) were paralyzed, weak or strong in each patient. Examiners tested flexion - extension and radial - ulnar deviation against resistance and palpated wrist motor tendons. While palpating tendons, co-contractions were encouraged by soliciting finger extension to evaluate the FCU, thumb extension to evaluate the ECU, and finger flexion to evaluate the ECRB. Kappa values were 0.8 for the ECRL, 0.7 for the ECRB, 0.5 for the ECU, 0.8 for the FCR, 0.6 for the PL, and 0.8 for the FCU, indicating moderate to almost perfect agreement between examiners. Tendon palpation during muscle examination was adequate to identify complete paralysis, as well as weak and strong muscle contractions. This assessment helps to identify muscles that could be used during nerve or tendon transfer for reconstruction of extensive upper limb paralysis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Muscle oxygenation of superficial and deep regions in knee extensor and plantar flexor muscles during repeated isometric contractions.

    PubMed

    Kubo, K

    2015-04-01

    The purpose of this study was to investigate changes in muscle oxygenation of knee extensor and plantar flexor muscles during repeated muscle contractions under the same condition. In addition, we compared changes in muscle oxygenation between superficial and deep regions of both muscles. Eleven healthy males participated in this study. During repeated knee extensions and plantar flexions (50 repetitions at 50% of the isometric maximum voluntary contraction for 3 s with 3 s relaxations), blood volume and oxygen saturation (StO₂) of the vastus lateralis and medial gastrocnemius muscles (superficial and deep region of each muscle) were measured using near infrared spectroscopy. The decrement of StO₂at the end of exercises was greater in plantar flexor muscle than in knee extensor muscle (P<0.001). For both muscles, the decrement of StO₂at the end of exercises was greater in the deep region than in the superficial one (both P<0.001). These results suggested that the oxygen utilization of plantar flexor muscle and deep regions of each muscle were higher than that of knee extensor muscle and superficial regions of each muscle.

  14. Poor correlation between handgrip strength and isokinetic performance of knee flexor and extensor muscles in community-dwelling elderly women.

    PubMed

    Felicio, Diogo Carvalho; Pereira, Daniele Sirineu; Assumpção, Alexandra Miranda; de Jesus-Moraleida, Fabianna Resende; de Queiroz, Barbara Zille; da Silva, Juscelio Pereira; de Brito Rosa, Naysa Maciel; Dias, João Marcos Domingues; Pereira, Leani Souza Máximo

    2014-01-01

    To investigate the correlation between handgrip strength and performance of knee flexor and extensor muscles determined using an isokinetic dynamometer in community-dwelling elderly women. This was a cross-sectional study. Sample selection for the study was made by convenience, and 221 (71.07 ± 4.93 years) community-dwelling elderly women were included. Knee flexor and extensor muscle performance was measured using an isokinetic dynamometer Biodex System 3 Pro. The isokinetic variables chosen for analysis were peak torque, peak torque/bodyweight, total work/bodyweight, total work, average power, and agonist/antagonist ratio at the angular velocities of 60°/s and 180°/s. Assessment of handgrip strength was carried out using the Jamar dynamometer. Spearman's correlation coefficient was calculated to identify intervariable correlations. Only knee flexor peak torque (60°/s) and average power (60°/s), and knee extensor peak torque (180°/s) and total work (180°/s) were significantly (P < 0.05), yet poorly, correlated with handgrip strength (r < 0.30). The majority of analyses did not show any correlation between variables assessed by isokinetic dynamometer and handgrip dynamometer. Caution is required when generalizing handgrip strength as a predictor of global muscle strength in community-dwelling elderly women. © 2013 Japan Geriatrics Society.

  15. The effects of elbow joint angle change on the elbow flexor muscle activation in pulley with weight exercise.

    PubMed

    Kang, Taewook; Seo, Youngjoon; Park, Jaehoon; Dong, Eunseok; Seo, Byungdo; Han, Dongwook

    2013-09-01

    [Purpose] This research investigated the effect of angular variation of flexion of the elbow joint on the muscle activation of elbow flexor muscles. [Subjects] The research subjects were 24 male college students with a dominant right hand who had no surgical or neurological disorders and gave their prior written consent to participation with full knowledge of the method and purpose of this study. [Methods] The subjects' shoulder joints stayed in the resting position, and the elbow joint was positioned at angles of 55°, 70°, and 90°. The angle between the pulley with weights and forearm stayed at 90°. Surface electromyography was used to measure muscle activities. Three measurements were made at each elbow angle, and every time the angle changed, two minutes rest was given. [Result] The muscle activities of the elbow flexors showed significant changes with change in the elbow joint angle, except for the biceps brachii activities between the angles of 55° and 70° of elbow flexion. The muscle activities of the biceps brachii and brachioradialis showed angle-related changes in the order of 55°, which showed the biggest value, followed by 70° and 90°. [Conclusion] In order to improve muscle strength of the elbow flexor using a pulley system, it seems more effective to have a 90° angle between the pulley with weights and the forearm when the muscle is stretched to a length 20% greater than its resting position.

  16. Clinical use of a combined grasping and locking core suture technique for flexor tendon repair in zone II.

    PubMed

    Al-Qattan, Mohammad M

    2013-12-01

    Previous authors have used either a grasping or a locking technique for flexor tendon repair in zone II. A combined (grasping and locking) 10-strand repair was used by the author in 22 adults (n = 28 fingers) with lacerations of both flexor tendons in zone II. The combined repair is known to be strong (mean tensile strength of 164 N), and the technique was used in selected cases who were thought to be at higher risk of rupture either because of excessive digital oedema (in early tendon repairs) or because of tendon retraction (in late primary tendon repairs). The 10-strand repair was bulky and, hence, only the profundus tendon was repaired; and "venting" of the pulley system was done proximal to the repair site as recommended by other authors. Supervised early active mobilisation was done immediately after the operation. At final follow-up, the outcome was calculated using the original Strickland-Glogovac grading system. There were no ruptures and the final outcome was considered excellent in 19 patients (n = 25 fingers), good in two patients (n = 2 fingers), and fair in the remaining patient (n = 1 finger). It was concluded that the bulky 10-strand repair may be used for zone II finger flexor tendon lacerations as long as a profundus-(?) only repair and "venting" of the pulley system are performed.

  17. Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients.

    PubMed

    Huang, Han-Wei; Ju, Ming-Shaung; Lin, Chou-Ching K

    2016-05-01

    The aim of this study was to evaluate the flexor and extensor muscle tone of the upper limbs in patients with spasticity or rigidity and to investigate the difference in hypertonia between spasticity and rigidity. The two experimental groups consisted of stroke patients and parkinsonian patients. The control group consisted of age and sex-matched normal subjects. Quantitative upper limb pendulum tests starting from both flexed and extended joint positions were conducted. System identification with a simple linear model was performed and model parameters were derived. The differences between the three groups and two starting positions were investigated by these model parameters and tested by two-way analysis of variance. In total, 57 subjects were recruited, including 22 controls, 14 stroke patients and 21 parkinsonian patients. While stiffness coefficient showed no difference among groups, the number of swings, relaxation index and damping coefficient showed changes suggesting significant hypertonia in the two patient groups. There was no difference between these two patient groups. The test starting from the extended position constantly manifested higher muscle tone in all three groups. In conclusion, the hypertonia of parkinsonian and stroke patients could not be differentiated by the modified pendulum test; the elbow extensors showed a higher muscle tone in both control and patient groups; and hypertonia of both parkinsonian and stroke patients is velocity dependent.

  18. Effects of hip flexor training on sprint, shuttle run, and vertical jump performance.

    PubMed

    Deane, Russell S; Chow, John W; Tillman, Mark D; Fournier, Kim A

    2005-08-01

    Although hip flexion is integral in sports, hip flexion exercises are seldom emphasized in strength and conditioning for sports performance. This study aimed to determine whether a hip flexor resistance-training program could improve performance on a variety of tasks. Thirteen men and 11 women completed an 8-week hip flexion resistance-training program. Eleven men and 13 women served as controls. Isometric hip flexion strength, 40-yd dash time and the time for the first 10-yds, 4 x 5.8-m shuttle run time, and vertical jump height were evaluated at the beginning and end of the training and control period. Improvements were observed in the training group but not in the control group. Individuals in the training group improved hip flexion strength by 12.2% and decreased their 40-yd and shuttle run times by 3.8% and 9.0%, respectively. An increase in hip flexion strength can help to improve sprint and agility performance for physically active, untrained individuals.

  19. Enhanced physiological tremor deteriorates plantar flexor torque steadiness after bed rest.

    PubMed

    Mulder, Edwin R; Horstman, Astrid M; Gerrits, Karin; Massa, Mark; Kleine, Bert U; de Haan, Arnold; Belavý, Daniel L; Felsenberg, Dieter; Zwarts, Machiel; Stegeman, Dick F

    2011-04-01

    This study evaluated the effectiveness of resistance training to preserve submaximal plantar flexor (PF) torque steadiness following 60 days of bed rest (BR). Twenty-two healthy male subjects underwent either BR only (CTR, n=8), or BR plus resistance training (RT, n=14). The magnitude of torque fluctuations during steady submaximal isometric PF contractions (20%, 40%, 60% and 80% of maximum) were assessed before and after BR. Across contraction intensities, torque fluctuations (coefficient of variation, CV) increased more (P<0.05) after BR for CTR (from 0.31±0.10 to 0.92±0.63; P<0.001), than for RT (from 0.30±0.09 to 0.54±0.27; P<0.01). A shift in the spectral content of torque fluctuations towards increased rhythmic activity between 6.5 and 20Hz was observed in CTR only (P<0.05). H-reflex amplitude (H(max)/M(max) ratio) declined across groups from 0.57±0.18 before BR to 0.44±0.14 following BR (P<0.01) without correlation to CV. The present study showed that increased torque fluctuation after BR resulted from enhanced physiological tremor. Resistance training prevented the spectral shift in isometric PF torque fluctuation and offset ∼50% of the decline in performance associated with long-term BR.

  20. Active recovery of the finger flexors enhances intermittent handgrip performance in rock climbers.

    PubMed

    Baláš, Jiří; Michailov, Michail; Giles, David; Kodejška, Jan; Panáčková, Michaela; Fryer, Simon

    2016-10-01

    This study aimed to (1) evaluate the effect of hand shaking during recovery phases of intermittent testing on the time-force characteristics of performance and muscle oxygenation, and (2) assess inter-individual variability in the time to achieve the target force during intermittent testing in rock climbers. Twenty-two participants undertook three finger flexor endurance tests at 60% of their maximal voluntary contraction until failure. Performances of a sustained contraction and two intermittent contractions, each with different recovery strategies, were analysed by time-force parameters and near-infrared spectroscopy. Recovery with shaking of the forearm beside the body led to a significantly greater intermittent test time (↑ 22%, P < .05), force-time integral (↑ 28%, P < .05) and faster muscle re-oxygenation (↑ 32%, P < .05), when compared to the hand over hold condition. Further, the ratio of intermittent to continuous test time distinguished specific aerobic muscular adaptations among sport climbers (2.02), boulderers (1.74) and lower grade climbers (1.25). Lower grade climbers and boulderers produced shorter duration contractions due to the slower development of target force during the intermittent test, indicating worse kinaesthetic differentiation. Both the type of recovery and climbing discipline determined muscle re-oxygenation and intermittent performance in rock climbers.

  1. The effects of eccentric velocity on activation of elbow flexors: evaluation by magnetic resonance imaging.

    PubMed

    Kulig, K; Powers, C M; Shellock, F G; Terk, M

    2001-02-01

    To compare magnetic resonance imaging (MRI) signal intensity changes in the primary elbow flexors during two isotonic exercise protocols varying in eccentric velocity and the ratio of eccentric to concentric activity. Twelve men performed two exercise protocols. The right and left arms were randomly assigned to one of two protocols that had the same workload (60% 1RM) and same total time of exercise (144 s) but differed in the velocity and ratio of eccentric to concentric activity (1:1 and 5:1 for the fast and slow protocols, respectively). MRI signal intensity changes were quantified pre- and post-exercises using an inversion recovery sequence with a 1.5T MRI system (TR = 2500 ms, TE = 90 ms, TI = 140 ms). Percent change in MRI signal intensity, rate of perceived exertion (RPE), and delayed onset muscle soreness (DOMS) were recorded and analyzed. The biceps brachii was found to be preferentially recruited during the fast protocol compared with the brachialis, whereas the brachialis was found to be preferentially recruited during the slow protocol (P < 0.05). The fast exercise protocol was perceived as being more strenuous (RPE = 8.3 +/- 2.1) than the slow (RPE = 5.4 +/- 1.5, P < 0.05) and produced DOMS in 58% of the tested subjects. These results suggest that agonists respond to various loading conditions nonhomogeneously. These findings may have implications with respect to exercise prescriptions for specific muscles.

  2. Cortical excitability is not depressed in movement-modulated stretch response of human thumb flexor.

    PubMed

    Wallace, C J; Miles, T S

    2001-08-01

    There is strong evidence that the predominant pathway of the long-latency stretch reflex for flexor pollicis longus crosses the motor cortex. This reflex response is diminished during active thumb movements. We tested the hypothesis that this could be due to a decrease in the excitability of the transcortical component during movement. During isometric, concentric and eccentric thumb movements, transcranial magnetic stimulation (TMS) of the motor cortex was given at a time when the reflex signal was traversing the motor cortex. TMS was also given earlier in separate runs when the signal was traversing the spinal cord under each of the three contractile conditions. The electromyogram was analysed for non-linear summation between stretch responses and the potential evoked by the cortical stimulus. The response to TMS alone was uniform across the three types of contraction, and the lack of cortical involvement in the short-latency reflex was confirmed. The TMS-evoked response summed in a non-linear manner with the long-latency reflex response, confirming that the excitability of the motor cortex was increased as the reflex signal passed through it. The long-latency response was markedly depressed during isotonic compared with isometric contractions. However, the non-linear summation was not greater during the isometric contractions. Thus, the depressed reflex responses during isotonic movements do not stem from reduced motor cortical responsiveness or afferent input to the transcortical pathway, and may instead reflect modulation of cutaneous reflexes during isotonic contractions.

  3. Increased rate of force development of elbow flexors by antagonist conditioning contraction.

    PubMed

    Kamimura, Takashi; Yoshioka, Koichi; Ito, Susumu; Kusakabe, Tatsumi

    2009-08-01

    The effects of isometric antagonist conditioning contraction (ACC) at various durations and intensities on the contractile force, electromyographic (EMG) amplitude, and their rates of rise of elbow flexor muscles were examined in healthy participants. In particular, we focused on the change in the maximum rate of initial force development of agonists (dFagonist/dt(max)), which was evaluated by subtracting antagonist force decaying from apparent initial force development. While the ACC caused no statistically significant effect on the average force during elbow flexion, dFagonist/dt(max) was significantly increased by the ACC of short durations (1-2s) and large intensities. Similarly, the ACC did not affect the root mean square EMG amplitude of biceps brachii during elbow flexion, but significantly increased the maximum rate of rise of the absolute EMG amplitude (dE/dt(max)). These results suggested that facilitating effects of the ACC could be observed in the initial phase of agonist action in healthy participants, and ACC of shorter durations might be more effective. The increased dE/dt(max) suggested that increased neural activities might contribute to the antagonist conditioned facilitation of force development.

  4. Flexor digitorum brevis transfer for floating toe prevention after Weil osteotomy: a cadaveric study.

    PubMed

    Lee, Lydia C; Charlton, Timothy P; Thordarson, David B

    2013-12-01

    A floating toe deformity occurs in many patients who undergo Weil osteotomies. It is likely caused by the failure of the windlass mechanism in shortening the metatarsal. For patients who require a proximal interphalangeal (PIP) joint arthroplasty or fusion in addition to a Weil osteotomy, the transfer of the flexor digitorum brevis (FDB) tendon to the PIP joint might restore the windlass mechanism and decrease the incidence of floating toes. Fourteen cadaveric foot specimens were examined to determine the effects of changing metatarsal length as well as tensioning the FDB tendon on the angle of the metatarsophalangeal (MTP) joint as a measure of a floating toe. Shortening and lengthening the second metatarsal resulted in a significant change in MTP angle (P = .03 and .02, respectively), though there was no clear relationship found between the amount of change in metatarsal length and the change in MTP angle. Transferring the FDB to a PIP arthroplasty site plantarflexed the MTP joint and corrected floating toes; the change in angle was significant compared with the control and shortening groups (P = .0001 and .002, respectively). This study supports the theory that change in length of the metatarsal, possibly via the windlass mechanism, plays a role in the pathophysiology of the floating toe deformity. Tensioning and transferring the FDB tendon into the PIP joint helped prevent the floating toe deformity in this cadaveric model. Continued research in this subject will help to refine methods of prevention and correction of the floating toe deformity.

  5. [Isokinetic profile of knee flexors and extensors in a population of rugby players].

    PubMed

    Larrat, E; Kemoun, G; Carette, P; Teffaha, D; Dugue, B

    2007-06-01

    We aimed to assess the isokinetic profile of the flexor and extensor muscles of the knee within a population of rugby players. This was a descriptive study. The rugby players underwent bilateral isokinetic assessment of knee flexion and extension on a CON-TREX MJ isokinetic dynamometer functioning at four angular frequencies - 90, 120, 180 and 240 degrees/s - in a concentric manner. The isokinetic parameters were peak torque, mean power, and mean work in relation to weight and femoral bicep: quadriceps ratio. The population included 16 "Federal 1" (semi-professional) rugby players with mean age 25 years (range 20-33 years). The players were divided into two groups: "forward" players (props, hookers, second line, third line) and "back" players (scrum, inside, center, wing, tail). The values of the isokinetic parameters did not reveal use of a preferred limb. Consequently, peak torque and mean power were higher in forward players than back players, whereas back players showed a higher relative power throughout the isokinetic test. Among rugby players, forward and back players showed differences in several isokinetic parameters. Accurate knowledge of the equilibrium between the knee's effector muscles is important for stability of the joint, to not only minimize articular accidents but also pinpoint force imbalances, thereby preventing muscular lesions during the sports season.

  6. Is the psoas a hip flexor in the active straight leg raise?

    PubMed

    Hu, Hai; Meijer, Onno G; van Dieën, Jaap H; Hodges, Paul W; Bruijn, Sjoerd M; Strijers, Rob L; Nanayakkara, Prabath W B; van Royen, Barend J; Wu, Wen Hua; Xia, Chun

    2011-05-01

    Psoas function is a topic of considerable relevance in sports and clinical science. However, the literature on psoas function is not sufficiently consistent. Questions are, amongst others, if during hip flexion the psoas always has the same function as the iliacus, and if the psoas affects the hip more than the lumbar spine. In the present study, 17 healthy women, 20-40 years, performed the active straight leg raise (ASLR), with the right or the left leg ("Side"), and without or with weight added above the ankle ("Condition"). Electromyographic (EMG) activity of psoas and iliacus were recorded with fine-wire electrodes, and of rectus femoris and adductor longus with surface electrodes, all on the right side. Movements of the leg were recorded with active markers and a camera system. During ASLR, the iliacus, rectus femoris, adductor longus and psoas were active ipsilaterally, but psoas was also active contralaterally. All muscles started to contract before movement onset, the iliacus, rectus femoris, and adductor longus largely at the same time, before the psoas. There was no significant difference between the amplitude or time of onset of ipsilateral and contralateral psoas EMG activity, nor was there a significant interaction between Side and Condition for the psoas. Although ipsilateral psoas activity is consistent with the psoas being a hip flexor, contralateral activity is not. The most simplest explanation of the pattern found is that the psoas is bilaterally recruited to stabilize the lumbar spine, probably in the frontal plane.

  7. Paired Associative Stimulation Induces Change in Presynaptic Inhibition of Ia Terminals in Wrist Flexors in Humans

    PubMed Central

    Russmann, Heike; Shamim, Ejaz A.; Meunier, Sabine; Hallett, Mark

    2010-01-01

    Enhancements in the strength of corticospinal projections to muscles are induced in conscious humans by paired associative stimulation (PAS) to the motor cortex. Although most of the previous studies support the hypothesis that the increase of the amplitude of motor evoked potentials (MEPs) by PAS involves long-term potentiation (LTP)-like mechanism in cortical synapses, changes in spinal excitability after PAS have been reported, suggestive of parallel modifications in both cortical and spinal excitability. In a first series of experiments (experiment 1), we confirmed that both flexor carpi radialis (FCR) MEPs and FCR H reflex recruitment curves are enhanced by PAS. To elucidate the mechanism responsible for this change in the H reflex amplitude, we tested, using the same subjects, the hypothesis that enhanced H reflexes are caused by a down-regulation of the efficacy of mechanisms controlling Ia afferent discharge, including presynaptic Ia inhibition and postactivation depression. To address this question, amounts of both presynaptic Ia inhibition of FCR Ia terminals (D1and D2 inhibitions methods; experiment 2) and postactivation depression (experiment 3) were determined before and after PAS. Results showed that PAS induces a significant decrease of presynaptic Ia inhibition of FCR terminals, which was concomitant with the facilitation of the H reflex. Postactivation depression was unaffected by PAS. It is argued that enhancement of segmental excitation by PAS relies on a selective effect of PAS on the interneurons controlling presynaptic inhibition of Ia terminals. PMID:20538768

  8. Parathyroid hormone 1-34 enhances extracellular matrix deposition and organization during flexor tendon repair.

    PubMed

    Lee, Daniel J; Southgate, Richard D; Farhat, Youssef M; Loiselle, Alayna E; Hammert, Warren C; Awad, Hani A; O'Keefe, Regis J

    2015-01-01

    Parathyroid hormone (PTH) 1-34 is known to enhance fracture healing. Tendon repair is analogous to bone healing in its dependence on the proliferation and differentiation of mesenchymal stem cells, matrix formation, and tissue remodeling.(1,2,3) We hypothesized that PTH 1-34 enhances tendon healing in a flexor digitorum longus (FDL) tendon repair model. C57Bl/6J mice were treated with either intraperitoneal PTH 1-34 or vehicle-control (PBS). Tendons were harvested at 3-28 days for histology, gene expression, and biomechanical testing. The metatarsophalangeal joint range of motion was reduced 1.5-2-fold in PTH 1-34 mice compared to control mice. The gliding coefficient, a measure of adhesion formation, was 2-3.5-fold higher in PTH 1-34 mice. At 14 days post-repair, the tensile strength was twofold higher in PTH 1-34 specimens, but at 28 days there were no differences. PTH 1-34 mice had increased fibrous tissue deposition that correlated with elevated expression of collagens and fibronectin as seen on quantitative PCR. PTH 1-34 accelerated the deposition of reparative tissue but increased adhesion formation.

  9. Is Enhanced-Eccentric Resistance Training Superior to Traditional Training for Increasing Elbow Flexor Strength?

    PubMed Central

    Barstow, Ian K.; Bishop, Mark D.; Kaminski, Thomas W.

    2003-01-01

    Protocols for strengthening muscle are important for fitness, rehabilitation, and the prevention of myotendinous injuries. In trained individuals, the optimal method of increasing strength remains unclear. The purpose of this study was to compare the effects of a traditional method of strengthening with a method that allowed for enhanced-eccentric training, on changes in elbow flexor strength in trained subjects. Thirty-nine (8 male, 31 female) trained subjects with normal elbow function participated in this study. Subjects were rank-ordered according to isometric force production and randomly assigned to one of three training groups: control (CONT), traditional concentric/eccentric (TRAD), and concentric/enhanced-eccentric (NEG). The training groups completed 24 training sessions. An evaluator blinded to training group performed all testing. Mixed model ANOVA techniques were used to determine if differences existed in concentric one repetition maximum strength, and isometric force production among groups. Changes in peak and average isokinetic force production were also compared. Type 1 error was maintained at 5%. While both groups improved concentric one repetition maximum (NEG = 15.5%, TRAD = 13.8%) neither training group statistically differed from changes demonstrated by the CONT group. Nor did either training group show significant improvements in isometric or isokinetic force production over the CONT group. These results do not support the superiority of enhanced-eccentric training for increasing force production in trained subjects. PMID:24616612

  10. Effect of shock wave therapy on ankle plantar flexors spasticity in stroke patients.

    PubMed

    Sawan, Salah; Abd-Allah, Foad; Hegazy, Montasser M; Farrag, Mohammad A; El-Den, Nancy Hosney Sharf

    2017-01-01

    Large number of patients with first-ever stroke developed spasticity. Spasticity can reduce the range of motion, hinder voluntary movements, provoke pain, and result in impairment of functional activities of daily living. Demonstrate the effect of shock wave therapy on ankle plantar flexors spasticity in stroke patients. We included forty ischemic stroke patients divided into 2 groups; group I were subjected to the selected physical therapy program and shock wave therapy whereas group II received the selected physical therapy program as well as placebo shock wave for six weeks. Both groups were subjected to pre- and post-treatment assessment by H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking. Baseline characteristics showed no significant difference between the two groups regarding the grades of spasticity. Whereas After treatment, there were a highly significant difference between both groups regarding the grades of spasticity according to the 3 parameters, H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking test (P values; <0.001, 0.006, and 0.009 respectively). Shock wave therapy is effective in controlling spasticity, increase dorsiflexion active range of motion of ankle and improving ten- meters walking test in stroke patients.

  11. [Rehabilitation after secondary surgery of the flexor tendons of fingers and thumb].

    PubMed

    Foisneau-Lottin, A; Touillet, A; Paysant, J; Dautel, G

    2014-12-01

    The repair of the finger flexor tendons can be complicated by the appearance of ruptures and peritendinous adhesions. Ruptures are often treated with tendon grafts. Peritendinous adhesions can require tenolysis. Following these two surgical procedures, there is a risk of new adhesions and rupture. Rehabilitation after this secondary surgery consists of a tailored, closely supervised protocol. Protocols used by the team at the Physical Medicine and Rehabilitation Department of the Regional Rehabilitation Institute and the team at the Plastic and Reconstructive Surgery Department of the Emile-Gallé Surgical Center of Nancy (France) are described. A close collaboration between these teams of surgeons and physical therapists is essential. After tendon grafting, protected early motion helps to move the transplant immediately while still protecting it. After tenolysis, immediate (several times a day) and extended rehabilitation ensures that the mobility obtained intraoperatively is maintained. It is performed in a specialized rehabilitation center during the first three postoperative weeks. The goal is to prevent new adhesions from forming while taking into account tendon's fragility.

  12. A review on animal models and treatments for the reconstruction of Achilles and flexor tendons.

    PubMed

    Bottagisio, Marta; Lovati, Arianna B

    2017-03-01

    Tendon is a connective tissue mainly composed of collagen fibers with peculiar mechanical properties essential to functional movements. The increasing incidence of tendon traumatic injuries and ruptures-associated or not with the loss of tissue-falls on the growing interest in the field of tissue engineering and regenerative medicine. The use of animal models is mandatory to deepen the knowledge of the tendon healing response to severe damages or acute transections. Thus, the selection of preclinical models is crucial to ensure a successful translation of effective and safe innovative treatments to the clinical practice. The current review is focused on animal models of tendon ruptures and lacerations or defective injuries with large tissue loss that require surgical approaches or grafting procedures. Data published between 2000 and 2016 were examined. The analyzed articles were compiled from Pub Med-NCBI using search terms, including animal model(s) AND tendon augmentation OR tendon substitute(s) OR tendon substitution OR tendon replacement OR tendon graft(s) OR tendon defect(s) OR tendon rupture(s). This article presents the existing preclinical models - considering their advantages and disadvantages-in which translational progresses have been made by using bioactive sutures or tissue engineering that combines biomaterials with cells and growth factors to efficiently treat transections or large defects of Achilles and flexor tendons.

  13. Effects of prior dynamic leg exercise on static effort of the elbow flexors.

    PubMed

    Yates, J W; Gladden, L B; Cresanta, M K

    1983-09-01

    The isometric endurance of the elbow flexors was determined in a control condition and subsequent to a maximal effort exercise bout on a cycle ergometer in seven subjects. Maximum voluntary contraction (MVC), peak rate of tension development (+dP/dt), peak rate of tension relaxation (-dP/dt), one-half contraction time, and one-half relaxation time were also measured. Each subject was tested on four occasions: two control and two experimental sessions. During the control sessions each subject held 40% of MVC to exhaustion, whereas the experimental session included a 1-min maximal effort exercise bout on a cycle ergometer 6 min prior to the isometric endurance task. Arterialized blood samples were drawn and analyzed for lactate, pH, PCO2, and PO2. Plasma bicarbonate was calculated from the Henderson-Hasselbalch equation. Subsequent to the cycle ergometer bout, blood lactate concentration rose from 0.8 to 11 mM, pH decreased from 7.43 to 7.20, PCO2 decreased from 40 to 32 Torr, and plasma bicarbonate decreased from 26 to 12 mM. When compared with the control values, no significant changes were evident for any muscle contractile properties following the cycle ergometer bout. However, isometric endurance was significantly reduced from 115.0 +/- 7.2 to 86.3 +/- 7.3 s.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain

    PubMed Central

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain. PMID:26957772

  15. The effect of distraction strategies on pain perception and the nociceptive flexor reflex (RIII reflex).

    PubMed

    Ruscheweyh, Ruth; Kreusch, Annette; Albers, Christoph; Sommer, Jens; Marziniak, Martin

    2011-11-01

    Distraction from pain reduces pain perception, and imaging studies have suggested that this may at least partially be mediated by activation of descending pain inhibitory systems. Here, we used the nociceptive flexor reflex (RIII reflex) to directly quantify the effects of different distraction strategies on basal spinal nociception and its temporal summation. Twenty-seven healthy subjects participated in 3 distraction tasks (mental imagery, listening to preferred music, spatial discrimination of brush stimuli) and, in a fourth task, concentrated on the painful stimulus. Results show that all 3 distraction tasks reduced pain perception, but only the brush task also reduced the RIII reflex. The concentration-on-pain task increased both pain perception and the RIII reflex. The extent of temporal summation of pain perception and the extent of temporal summation of the RIII reflex were not affected by any of the tasks. These results suggest that some, but not all, forms of pain reduction by distraction rely on descending pain inhibition. In addition, pain reduction by distraction seems to preferentially affect mechanisms of basal nociceptive transmission, not of temporal summation. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  16. Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting.

    PubMed

    Falla, Deborah; O'Leary, Shaun; Fagan, Amy; Jull, Gwendolen

    2007-05-01

    Specific strategies to optimally facilitate postural muscles to retrain postural form are advocated in the clinical management of neck pain. The purpose of this study was to compare the activation of selected cervical, thoracic and lumbar muscles during independent and facilitated postural correction in sitting in 10 subjects with chronic neck pain. Deep cervical flexor (DCF) muscle activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the thoracic erector spinae and lumbar multifidus muscles. Root-mean-square EMG amplitude was measured for each muscle across two conditions. In the first condition, subjects were instructed to spontaneously "sit up straight" from a slumped posture without any other guidance from the therapist. In the second condition the therapist provided specific manual and verbal facilitation to assist the patient to correct to an upright pelvic position with a neutral spinal lumbo-pelvic position. Activation of the DCF and lumbar multifidus muscles (P<0.05) were significantly greater when the therapist facilitated postural correction compared to independent sitting correction. Specific postural-correction strategies result in better facilitation of key postural muscles compared to non-specific postural advice. The results of this study highlight the need for clinical skill and precision in postural training of patients with neck pain.

  17. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain.

    PubMed

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain.

  18. Application of sonoelastography for evaluating the stiffness of equine superficial digital flexor tendon during healing.

    PubMed

    Tamura, N; Kuroda, T; Kotoyori, Y; Fukuda, K; Nukada, T; Kato, T; Kuwano, A; Kasashima, Y

    2017-02-04

    Sonoelastography can assess the inner stiffness of tissues. Sonoelastographic evaluation of injured equine superficial digital flexor tendons (SDFTs) is considered to be useful for assessing the stiffness of a lesion even during late-stage rehabilitation. The purpose of this study was to investigate and compare the sonoelastographic appearance of injured SDFTs over time from the onset of the injury. Eighteen horses were classified into three groups according to the length of time from injury onset: group A, within two weeks after injury; group B, approximately five months after injury; and group C, approximately nine months after injury. Longitudinal and transverse images of all injured SDFTs were obtained using grey-scale ultrasonography and sonoelastography. Grey-scale and sonoelastographic images were evaluated by two observers using echogenicity-grading and colour-grading systems, respectively. The authors evaluated the interobserver agreement and compared the grades among the three groups. The results indicated almost perfect interobserver agreement. Significant differences were found in the sonoelastography among the three groups, whereas no significant difference was found in the grey-scale ultrasonography between groups B and C. Sonoelastography is a feasible and useful modality to evaluate the equine injured SDFTs in vivo and to distinguish between them among the different phases even during the chronic phase.

  19. Determination of Injection Site in Flexor Digitorum Longus for Effective and Safe Botulinum Toxin Injection

    PubMed Central

    Kim, Hong Geum; Chung, Myung Eun; Song, Dae Heon; Kim, Ju Yong; Sul, Bo Mi; Oh, Chang Hoon

    2015-01-01

    Objective To determine the optimal injection site in the flexor digitorum longus (FDL) muscle for effective botulinum toxin injection. Methods Fourteen specimens from eight adult Korean cadavers were used in this study. The most proximal medial point of the tibia plateau was defined as the proximal reference point; the most distal tip of the medial malleolus was defined as the distal reference point. The distance of a line connecting the proximal and distal reference points was defined as the reference length. The X-coordinate was the distance from the proximal reference point to the intramuscular motor endpoint (IME), or motor entry point (MEP) on the reference line, and the Y-coordinate was the distance from the nearest point from MEP on the medial border of the tibia to the MEP. IME and MEP distances from the proximal reference point were evaluated using the raw value and the X-coordinate to reference length ratio was determined as a percentage. Results The majority of IMEs were located within 30%-60% of the reference length from the proximal reference point. The majority of the MEPs were located within 40%-60% of the reference length from the proximal reference point. Conclusion We recommend the anatomical site for a botulinum toxin injection in the FDL to be within a region 30%-60% of the reference length from the proximal reference point. PMID:25750869

  20. Older adults use a unique strategy to lift inertial loads with the elbow flexor muscles.

    PubMed

    Graves, A E; Kornatz, K W; Enoka, R M

    2000-04-01

    The purpose of this study was to determine the effect of age on the ability to exert steady forces and to perform steady flexion movements with the muscles that cross the elbow joint. An isometric task required subjects to exert a steady force to match a target force that was displayed on a monitor. An anisometric task required subjects to raise and lower inertial loads so that the angular displacement around the elbow joint matched a template displayed on a monitor. Steadiness was measured as the coefficient of variation of force and as the normalized standard deviation of wrist acceleration. For the isometric task, steadiness as a function of target force decreased similarly for old adults and young adults. For the anisometric task, steadiness increased as a function of the inertial load and there were significant differences caused by age. Old adults were less steady than young adults during both shortening and lengthening contractions with the lightest loads. Furthermore, old adults were least steady when performing lengthening contractions. These behaviors appear to be associated with the patterns of muscle activation. These results suggest that different neural strategies are used to control isometric and anisometric contractions performed with the elbow flexor muscles and that these strategies do not change in parallel with advancing age.

  1. Efficiency of the flexor tendon pulley system in human cadaver hands.

    PubMed

    Rispler, D; Greenwald, D; Shumway, S; Allan, C; Mass, D

    1996-05-01

    The efficiency of the flexor tendon system was examined in a human cadaver model. Pulleys were randomly sectioned, and the results were evaluated on the basis of the tendon excursion, force generated at the fingertip, and the work (force multiplied by distance) involved, as compared to the intact pulley system. When a single minor pulley (A1 or A5) was cut, there was no statistical difference in work efficiency or excursion efficiency from controls. Cutting all minor pulleys (A1, A3, A5) lead to a significant loss in excursion efficiency. The intact three pulley systems of A2, A3, and A4 were near normal and statistically better than A2 and A4 together for work efficiency. Cutting one of the major pulleys (A2, A4) resulted in significant changes in efficiency, but what was unexpected was to find an 85% loss of both work and excursion efficiency for the loss of A4 but only an excursion difference of 94% for the loss of A2. Our findings demonstrated that in this model, with the influence of the skin removed, A4 absence produced the largest biomechanically measured efficiency changes and that a combination of A2, A3, and A4 was necessary to preserve both work and excursion efficiency.

  2. Reconstruction of the digital flexor pulley system: a retrospective comparison of two methods of treatment.

    PubMed

    Arora, R; Fritz, D; Zimmermann, R; Lutz, M; Kamelger, F; Klauser, A S; Gabl, M

    2007-02-01

    The rare injury of closed rupture of the A2 and A3 flexor pulleys was treated using two non-encircling techniques of pulley reconstruction. Thirteen patients were treated with an extensor retinaculum graft (Group A). At a mean follow-up time of 48 months, the average PIP flexion was 97%, the power grip strength 96%, the pinch grip strength 100% and the thickening 94% of the uninjured side. Ten patients were treated with a free palmaris longus tendon grafts (Group B). At a mean follow-up time of 57 months, the average PIP flexion was 94%, the power grip strength 98%, the pinch grip strength 100% and the thickening 95% of the uninjured side. In both groups, finger extension was unrestricted. The Buck Gramcko score included 10 excellent, two good and one fair result in Group A and seven excellent, two good and one fair result in Group B. Both techniques proved beneficial. All climbers returned to their previous standard and all non-climbers regained full finger dexterity in their previous job.

  3. Determination of equine deep digital flexor muscle volume based on distances between anatomical landmarks.

    PubMed

    Hardeman, L C; van der Meij, B R; Lamers, A A H; van der Kolk, J H; Back, W; Wijnberg, I D

    2014-10-01

    In equine medicine the use of Botox® is experimental. Dosages are determined from human treatment-protocols and limited numbers of equine studies. Determination of target-muscle volume can be helpful to extrapolate human dosages. The aim of the study was to calculate a formula enabling the estimation of the deep digital flexor muscle (DDFM) volume based on distances between anatomical landmarks. Nineteen cadaveric limbs were collected and distance A (top of olecranon to Os carpi accessorium) and B (circumference of limb) were measured. Converting mathematical formulas, C was calculated: π × (((0.5B)/π)(2)) × A. DDFM volume was determined by water displacement. Linear Regression Analysis was used to analyse data. The line best fitting the observed points was: Ln(volume[ml]) = -1.89 + 0.98 × Ln(value C[cm(3)]). Correlation was highest when natural logarithm was applied to both variables and was 0.97. The calculated formula enables estimating DDFM volume of a living horse. This estimated volume can be useful to apply human Botox® treatment-protocols.

  4. Computer aided quantification of pathological features for flexor tendon pulleys on microscopic images.

    PubMed

    Liu, Yung-Chun; Chen, Hsin-Chen; Shih, Hui-Hsuan; Yang, Tai-Hua; Yang, Hsiao-Bai; Yang, Dee-Shan; Su, Fong-Chin; Sun, Yung-Nien

    2013-01-01

    Quantifying the pathological features of flexor tendon pulleys is essential for grading the trigger finger since it provides clinicians with objective evidence derived from microscopic images. Although manual grading is time consuming and dependent on the observer experience, there is a lack of image processing methods for automatically extracting pulley pathological features. In this paper, we design and develop a color-based image segmentation system to extract the color and shape features from pulley microscopic images. Two parameters which are the size ratio of abnormal tissue regions and the number ratio of abnormal nuclei are estimated as the pathological progression indices. The automatic quantification results show clear discrimination among different levels of diseased pulley specimens which are prone to misjudgments for human visual inspection. The proposed system provides a reliable and automatic way to obtain pathological parameters instead of manual evaluation which is with intra- and interoperator variability. Experiments with 290 microscopic images from 29 pulley specimens show good correspondence with pathologist expectations. Hence, the proposed system has great potential for assisting clinical experts in routine histopathological examinations.

  5. Effect of eccentric contraction velocity on muscle damage in repeated bouts of elbow flexor exercise.

    PubMed

    Barroso, Renato; Roschel, Hamilton; Ugrinowitsch, Carlos; Araújo, Rubens; Nosaka, Kazunori; Tricoli, Valmor

    2010-08-01

    Eccentric exercise induces muscle damage, but controversy exists concerning the effect of contraction velocity on the magnitude of muscle damage, and little is known about the effect of contraction velocity on the repeated-bout effect. This study examined slow (60 degrees.s(-1)) and fast (180 degrees.s(-1)) velocity eccentric exercises for changes in indirect markers of muscle damage following 3 exercise bouts that were performed every 2 weeks. Fifteen young men were divided into 2 groups based on the velocity of eccentric exercise: 7 in the Ecc60 (60 degrees.s(-1)) group, and 8 in the Ecc180 (180 degrees.s(-1)) group. The exercise consisted of 30 maximal eccentric contractions of the elbow flexors at each velocity, in which the elbow joint was forcibly extended from 60 degrees to 180 degrees (full extension) on an isokinetic dynamometer. Changes in maximal voluntary isometric contraction strength, range of motion, muscle soreness, and plasma creatine kinase activity before and for 4 days after the exercise were compared in the 2 groups using a mixed-model analysis (groupxboutxtime). No significant differences between groups were evident for changes in any variables following exercise bouts; however, the changes were significantly smaller (p<0.05) after the second and third bouts than after the first bout. These results indicate that the contraction velocity does not influence muscle damage or the repeated-bout effect.

  6. Assessment of eccentric exercise-induced muscle damage of the elbow flexors by tensiomyography.

    PubMed

    Hunter, Angus M; Galloway, Stuart D R; Smith, Iain J; Tallent, Jamie; Ditroilo, Massimiliano; Fairweather, Malcolm M; Howatson, Glyn

    2012-06-01

    Exercise induced muscle damage (EIMD) impairs maximal torque production which can cause a decline in athletic performance and/or mobility. EIMD is commonly assessed by using maximal voluntary contraction (MVC), creatine kinase (CK) and muscle soreness. We propose as an additional technique, tensiomyography (TMG), recently introduced to measure mechanical and muscle contractile characteristics. The purpose of this study was to determine the validity of TMG in detecting changes in maximal torque following EIMD. Nineteen participants performed eccentric elbow flexions to achieve EIMD on the non- dominant arm and used the dominant elbow flexor as a control. TMG parameters, MVC and rate of torque development (RTD) were measured prior to EIMD and repeated for another six consecutive days. Creatine kinase, muscle soreness and limb girth were also measured during this period. Twenty four hours after inducing EIMD, MVC torque, RTD and TMG maximal displacement had significantly (p<0.01) declined by 37%, 44% and 31%, respectively. By day 6 MVC, RTD and TMG recovered to 12%, 24% and 17% of respective pre-EIMD values. In conclusion, as hypothesised TMG maximal displacement significantly followed other standard EIMD responses. This could therefore be useful in detecting muscle damage from impaired muscle function and its recovery following EIMD.

  7. Morphological study of the Golgi tendon organ in equine superficial digital flexor tendon.

    PubMed

    Watanabe, Takafumi; Hosaka, Yoshinao; Yamamoto, Etsuko; Ueda, Hiromi; Tangkawattana, Prasarn; Takehana, Kazushige

    2004-08-01

    The Golgi tendon organ (GTO) is an encapsulated fusiform mechanoreceptor siding in the musculo-tendinous junction of many animal species. Inhibitory function of afferent nerve fibers distributed from nearby motor units, the organ responds to active tension exerted onto the muscle. The morphological features of the equine GTO have not yet been elucidated. Additionally, there is some controversy regarding to the existence of the GTO in the equine superficial digital flexor tendon (SDFT). Therefore, immunohistochemistry and immunoelectron microscopy using alcian blue (pH 2.5) staining and the silver-enhanced colloidal gold method were carried out to determine both the location and characteristics of the GTO at the musculo-tendinous junction of the SDFT. A GTO with a fusiform structure of approximately 3 mm in length was found in the tendinous part. The lumen of the GTO was divided into compartments by septal cells. Each compartment contained collagen fibrils, nerve fibers and Schwann cells. This is the first report of the equine GTO.

  8. Mycobacterium fortuitum infection following primary achilles tendon debridement with flexor hallucis longus augmentation: a case report.

    PubMed

    Jacoby, Sidney M; Sivalingam, Jocelyn J; Raikin, Steven Mark

    2008-05-01

    Mycobacterium fortuitum (M. fortuitum), a rapidly growing non-tuberculous mycobacterium is a well-recognized, yet uncommon cause of soft tissue infection. The incidence of post surgical wound infections from this organism is increasing. The presentation of infection is atypical and failure to consider this pathogen can cause diagnostic delay and increased morbidity. Achilles tendon debridement with FHL augmentation is commonly used in patients with chronic Achilles tendinosis. Wound-edge necrosis is the most common surgical complication of this procedure, and superficial and deep infections are potentially devastating complications. We report the case of a patient who underwent Achilles tendon debridement with flexor hallucis longus augmentation, whose postoperative course was complicated by a deep M. FORTUITUM infection. Critical to the identification and ultimate treatment of this particular pathogen is the utilization of appropriate intraoperative cultures and microbiologic testing. In addition, repeat aggressive irrigation and debridement procedures coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy can result in a successful long-term outcome.

  9. Biomechanical Evaluation of Flexor Tendon Graft With Different Repair Techniques and Graft Surface Modification

    PubMed Central

    Wu, Jingheng; Thoreson, Andrew R.; Reisdorf, Ramona L.; An, Kai-Nan; Moran, Steven L.; Amadio, Peter C.; Zhao, Chunfeng

    2016-01-01

    The purpose of this study was to investigate the biomechanical properties of modified repair techniques for flexor tendon reconstruction and the effects of surface modification using carbodiimide-derivatized synovial fluid plus gelatin (cd-SF-G), compared to the traditional repair techniques. The second and fifth digits from 16 canine forepaws were randomly divided into 4 groups: (1) traditional graft repairs (TGR group) including distal Bunnell repair and proximal Pulvertaft weave repair; (2) modified graft repairs (MGR group) including distal graft bony attachment repair and proximal step-cut repair; (3) group TGR coated with cd-SF-G (TGR-C group); and (4) group MGR coated with cd-SF-G (MGR-C group). Digit normalized work of flexion (nWOF), ultimate failure strength, and stiffness were measured. The nWOF in MGR group was significantly less than TGR group (p < 0.05). The nWOF in groups treated with cd-SF-G was significantly less than their untreated counterparts (p < 0.05). Ultimate load to failure of the MGR-C group was significantly greater than the TGR-C group (p < 0.05), but no significant difference in stiffness was found between these two groups. The modified techniques cannot only improve tendon gliding abilities but can also improve breaking strength. Additionally, surface modification with cd-SF-G significantly decreased the work of flexion. PMID:25665071

  10. The high variability of the chiasma plantare and the long flexor tendons: Anatomical aspects of tendon transfer in foot surgery.

    PubMed

    Pretterklieber, Bettina

    2017-02-03

    As tendon transfer of the flexor hallucis longus (FHL) and the flexor digitorum longus (FDL) is an established procedure, exact knowledge of the formation of the chiasma plantare is of great interest. Although the quadratus plantae (QP) appears to play a major role, it has been rarely addressed in previous studies. The aim of the present study was to reinvestigate the formation of the chiasma plantare and the composition of the long flexor tendons in order to clarify the inexact and partly contradictory descriptions published from 1865 onward. The chiasma plantare and the long flexor tendons in both feet of 50 formalin-fixed specimens of body donors (25 men and women) were analyzed by gross anatomical dissection. It was composed of one (3%), two (69%) or three layers (28%) which were variably established by the tendinous and muscular fibers of the FHL, the FDL and the QP. In 61% the FHL gave one or more slips to the FDL, and in 39% there was a bidirectional interconnection between the two tendons. The slip from the FHL to the FDL largely reinforces the second (45%), or the second and third tendon (46%). Thus, the FHL is involved in the first tendon in all cases, in the second one in 97% of cases, and in the third tendon in about one half of cases (53%). In all instances, the FDL contributes to the third to fourth, in 98% the second, and in at least 39% to the first tendon. The QP reinforces the second to fourth tendon in nearly all cases, the fifth in about one half of cases, and even the first tendon in 14% of cases. In addition, the individual composition of the five long flexor tendons arising from the chiasma plantare was analyzed in detail. Special emphasis was placed on the evaluation of side and sex differences as well as individual symmetry. Furthermore, biomechanical, developmental and phylogenetic aspects were outlined. In terms of the outcome of this study, the FHL appears to be the better donor for tendon transfer to restore lost function, but

  11. Data Acquisition System(DAS) Sustaining Engineering

    NASA Technical Reports Server (NTRS)

    1998-01-01

    This paper presents general information describing the Data Acquisition System contract, a summary of objectives, tasks performed and completed. The hardware deliverables which are comprised of: 1) Two ground DAS units; 2) Two flight DAS units; 3) Logistic spares; and 4) Shipping containers are described. Also included are the data requirements and scope of the contract.

  12. The Effect of Body Mass on Eccentric Knee-Flexor Strength Assessed With an Instrumented Nordic Hamstring Device (Nordbord) in Football Players.

    PubMed

    Buchheit, Martin; Cholley, Yannick; Nagel, Mark; Poulos, Nicholas

    2016-09-01

    To examine the effect of body mass (BM) on eccentric knee-flexor strength using the Nordbord and offer simple guidelines to control for the effect of BM on knee-flexor strength. Data from 81 soccer players (U17, U19, U21, senior 4th French division, and professionals) and 41 Australian Football League (AFL) players were used for analysis. They all performed 1 set of 3 maximal repetitions of the bilateral Nordic hamstring exercise, with the greatest strength measure used for analysis. The main regression equation obtained from the overall sample was used to predict eccentric knee-flexor strength from a given BM (moderate TEE, 22%). Individual deviations from the BM-predicted score were used as a BM-free index of eccentric knee- flexor strength. There was a large (r = .55, 90% confidence limits .42;.64) correlation between eccentric knee-flexor strength and BM. Heavier and older players (professionals, 4th French division, and AFL) outperformed their lighter and younger (U17-U21) counterparts, with the soccer professionals presenting the highest absolute strength. Professional soccer players were the only ones to show strength values likely slightly greater than those expected for their BM. Eccentric knee-flexor strength, as assessed with the Nordbord, is largely BM-dependent. To control for this effect, practitioners may compare actual test performances with the expected strength for a given BM, using the following predictive equation: Eccentric strength (N) = 4 × BM (kg) + 26.1. Professional soccer players with specific knee-flexor-training history and enhanced neuromuscular performance may show higher than expected values.

  13. Low-intensity resistance training attenuates dexamethasone-induced atrophy in the flexor hallucis longus muscle.

    PubMed

    Macedo, Anderson G; Krug, André L O; Herrera, Naiara A; Zago, Anderson S; Rush, James W E; Amaral, Sandra L

    2014-09-01

    This study investigated the potential protective effect of low-intensity resistance training (RT) against dexamethasone (DEX) treatment induced muscle atrophy. Rats underwent either an 8 week period of ladder climbing RT or remained sedentary. During the last 10 days of the exercise protocol, animals were submitted to a DEX treatment or a control saline injection. Muscle weights were assessed and levels of AKT, mTOR, FOXO3a, Atrogin-1 and MuRF-1 proteins were analyzed in flexor hallucis longus (FHL), tibialis anterior (TA), and soleus muscles. DEX induced blood glucose increase (+46%), body weight reduction (-19%) and atrophy in FHL (-28%) and TA (-21%) muscles, which was associated with a decrease in AKT and an increase in MuRF-1 proteins levels. Low-intensity RT prevented the blood glucose increase, attenuated the FHL atrophy effects of DEX, and was associated with increased mTOR and reductions in Atrogin-1 and MuRF-1 in FHL. In contrast, TA muscle atrophy and signaling proteins were not affected by RT. These are the first data to demonstrate that low-intensity ladder-climbing RT specifically mitigates the FHL atrophy, which is the main muscle recruited during the training activity, while not preventing atrophy in other limb muscle not as heavily recruited. The recruitment-dependent prevention of atrophy by low intensity RT likely occurs by a combination of attenuated muscle protein degradation signals and enhanced muscle protein synthesis signals including mTOR, Atrogin-1 and MuRF-1. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. The effects of passive stretching plus vibration on strength and activation of the plantar flexors.

    PubMed

    Miller, Jonathan D; Herda, Trent J; Trevino, Michael A; Mosier, Eric M

    2016-09-01

    This study examined the effects of passive stretching only (PS+CON) and passive stretching with the addition of continuous vibration (VIB) during post-passive stretching tests (PS+VIB) on peak torque (PT), percent voluntary inactivation (%VI), single stimulus twitch torque (TTSINGLE), and doublet stimuli twitch torque (TTDOUBLET) of the plantar flexors at a short (20° plantar flexion (PF)) and long muscle length (15° dorsiflexion (DF)). Fourteen healthy men (age = 22 ± 3 years) performed isometric maximal voluntary contractions at PF and DF, and passive range of motion (PROM) assessments before and after 8 × 30-s passive stretches without (PS+CON) or with VIB (PS+VIB) administered continuously throughout post-passive stretching tests. The passive properties of the muscle tendon unit were assessed pre- and post-passive stretching via PROM, passive torque (PASSTQ), and musculotendinous stiffness (MTS) measurements. PT, TTSINGLE, and TTDOUBLET decreased, whereas, %VI increased following passive stretching at PF and DF (P < 0.05) with no significant differences between PS+CON and PS+VIB. PASSTQ and MTS decreased while PROM increased post-passive stretching during both trials (P < 0.05). The stretching-induced force/torque deficit and increases in %VI were evident following passive stretching at short and long muscle lengths. Although not statistically significant, effect size calculations suggested large and moderate differences in the absolute changes in PT (Cohen's d = 1.14) and %VI (Cohen's d = 0.54) from pre- to post-passive stretching between treatments, with PS+VIB having greater decreases of PT and higher %VI than PS+CON. The decrement in PT following passive stretching may be primarily neural in origin.

  15. Trunk extensor and flexor strength of long-distance race car drivers and physically active controls.

    PubMed

    Baur, Heiner; Muller, Steffen; Pilz, Frederike; Mayer, Patrizia; Mayer, Frank

    2010-09-01

    Seventy percent of motor sports athletes report low back pain. Information on the physical capacity of race car drivers is limited. The purpose of this study was to compare the maximum trunk extensor and flexor strength of elite race car drivers and physically active controls. Thirteen elite race car drivers and 13 controls were measured in concentric mode for maximal trunk flexion and extension at 60° x s(-1) and 120° x s(-1). Peak torque (mean ± s) at 60° x s(-1) in trunk extension was 283 ± 80 N x m in the drivers and 260 ± 88 N x m in controls (P > 0.05). At 120° x s(-1), drivers produced peak torques of 248 ± 55 N x m compared with 237 ± 74 N x m for controls (P > 0.05). Peak torques in flexion were less than in extension for both groups (60° x s(-1): drivers 181 ± 56 N x m, controls 212 ± 54 N x m, P > 0.05; 120° x s(-1): drivers 191 ± 57 N x m, controls 207 ± 48 N x m, P > 0.05). Individual ratios of flexion to extension forces exhibited ratios of 0.88 (60° x s(-1)) and 0.93 (120° x s(-1)) for controls and 0.66 (60° x s(-1)) and 0.77 (120° x s(-1)) for drivers (60° x s(-1): P > 0.05; 120° x s(-1): P > 0.05). The maximum strength performance capacity of the trunk muscles of elite motor sport athletes competing in long-distance racing did not differ from that of anthropometrically matched and physically active controls.

  16. Evidence of Preserved Oxidative Capacity and Oxygen Delivery in the Plantar Flexor Muscles With Age.

    PubMed

    Hart, Corey R; Layec, Gwenael; Trinity, Joel D; Liu, Xin; Kim, Seong-Eun; Groot, H Jonathan; Le Fur, Yann; Sorensen, Jacob R; Jeong, Eun-Kee; Richardson, Russell S

    2015-09-01

    Studies examining the effect of aging on skeletal muscle oxidative capacity have yielded equivocal results; however, these investigations may have been confounded by differences in oxygen (O(2)) delivery, physical activity, and small numbers of participants. Therefore, we evaluated skeletal muscle oxidative capacity and O(2) delivery in a relatively large group (N = 40) of young (22 ± 2 years) and old (73 ± 7 years) participants matched for physical activity. After submaximal dynamic plantar flexion exercise, phosphocreatine (PCr) resynthesis ((31)P magnetic resonance spectroscopy), muscle reoxygenation (near-infrared spectroscopy), and popliteal artery blood flow (Doppler ultrasound) were measured. The phosphocreatine recovery time constant (Tau) (young: 33 ± 16; old: 30 ± 11 seconds), maximal rate of adenosine triphosphate (ATP) synthesis (young: 25 ± 9; old: 27 ± 8 mM/min), and muscle reoxygenation rates determined by the deoxyhemoglobin/myoglobin recovery Tau (young: 48 ± 5; old: 47 ± 9 seconds) were similar between groups. Similarly, although tending to be higher in the old, there were no significant age-related differences in postexercise popliteal blood flow (area under the curve: young: 1,665 ± 227 vs old: 2,404 ± 357 mL, p = .06) and convective O(2) delivery (young: 293 ± 146 vs old: 404 ± 191 mL, p = .07). In conclusion, when physical activity and O(2) delivery are similar, oxidative capacity in the plantar flexors is not affected by aging. These findings reveal that diminished skeletal muscle oxidative capacity is not an obligatory accompaniment to the aging process.

  17. [Evaluation of perioperative analgesia by nociceptive flexor reflex in pigs under ketamine-azaperone-general anaesthesia].

    PubMed

    Rintisch, Ulf; Baars, Jan; Lahrmann, Karl-Heinz

    2012-01-01

    The objective of the investigation was to evaluate quantitatively the analgesic efficacy of the Ketamine-Azaperone-general anesthesia during surgical procedures on pigs by nociceptive flexor reflexes (NFR). The study was performed in 30 four to five month old male pigs which were castrated. The NFR was evoked every minute over the N. ulnaris by multiple electrical stimulation consisting of five single stimuli (2 Hz). The reflex response was derived electromyographically (EMG) by surface electrodes placed over the M. deltoideus. The root-mean-square amplitude within the time interval of 80-240 ms after the last stimulus was calculated as measure for the reflex size. The threshold was fixed at 40 microV. Beside electrical NFR recording the surgical tolerance was determined by the traditional interdigital reflex and the defense reaction to defined surgical test stimuli which were incisisions in the scrotal skin, in the tunica vaginalis and in the testis, pulling off the spermatic cord, clamping and cutting off the spermatic cord and final wound disinfection. All surgical pain stimuli were performed simultaneously with the electrical stimuli. After induction of anesthesia the NFR amplitude declined from 3500 microV below the threshold of 40 microV. At 98% of the surgical stimuli without defense reaction were below the reflex threshold. At 93% with defense reactions demonstrated reflex amplitudes above the threshold. When the interdigital reflex was suppressed, 89% of the NFR values fell below the threshold of 40 microV. These findings demonstrate a good correlation of NFR-amplitudes with reactions to traditional controls of analgesia.

  18. Enhanced propriospinal excitation from hand muscles to wrist flexors during reach-to-grasp in humans.

    PubMed

    Giboin, Louis-Solal; Lackmy-Vallée, Alexandra; Burke, David; Marchand-Pauvert, Véronique

    2012-01-01

    In humans, propriospinal neurons located at midcervical levels receive peripheral and corticospinal inputs and probably participate in the control of grip tasks, but their role in reaching movements, as observed in cats and primates, is still an open question. The effect of ulnar nerve stimulation on flexor carpi radialis (FCR) motor evoked potential (MEP) was tested during reaching tasks and tonic wrist flexion. Significant MEP facilitation was observed at the end of reach during reach-to-grasp but not during grasp, reach-to-point, or tonic contractions. MEP facilitation occurred at a longer interstimulus interval than expected for convergence of corticospinal and afferent volleys at motoneuron level and was not paralleled by a change in the H-reflex. These findings suggest convergence of the two volleys at propriospinal level. Ulnar-induced MEP facilitation was observed when conditioning stimuli were at 0.75 motor response threshold (MT), but not 1 MT. This favors an increased excitability of propriospinal neurons rather than depression of their feedback inhibition, as has been observed during tonic power grip tasks. It is suggested that the ulnar-induced facilitation of FCR MEP during reach may be due to descending activation of propriospinal neurons, assisting the early recruitment of large motoneurons for rapid movement. Because the feedback inhibitory control is still open, this excitation can be truncated by cutaneous inputs from the palmar side of the hand during grasp, thus assisting movement termination. It is concluded that the feedforward activation of propriospinal neurons and their feedback control may be involved in the internal model, motor planning, and online adjustments for reach-to-grasp movements in humans.

  19. Distribution of the forces produced by motor unit activity in the human flexor digitorum profundus

    PubMed Central

    Kilbreath, S L; Gorman, R B; Raymond, J; Gandevia, S C

    2002-01-01

    In humans, the flexor digitorum profundus (FDP), which is a multi-tendoned muscle, produces forces that flex the four distal interphalangeal joints of the fingers. We determined whether the force associated with activity in a single motor unit in the FDP was confined to a single finger or distributed to more than one finger during a natural grasp. The discharge of single low-threshold motor units (n = 69) was recorded at sites across the muscle during weak voluntary grasping involving all fingers and spike-triggered averaging of the forces under each of the finger pads was used to assess the distribution pattern. Spike-triggered averaging revealed that time-locked changes in force occurred under the ‘test’ finger (that finger on which the unit principally acted) as well as under the ‘non-test’ fingers. However, for the index-, middle- and ring-finger units, the changes in force under non-test fingers were typically small (< 20 % of those under the test finger). For little-finger units, the mean changes in force under the adjacent ring finger were large (>50 % of those under the test finger). The distribution of forces by little-finger units differed significantly from that for each of the other three fingers. Apart from increases in force under non-test fingers, there was occasional unloading of adjacent fingers (22/267 combinations), usually affecting the index finger. The increases in force under the test finger correlated significantly with the background force for units acting on the middle, ring and little fingers. During a functional grasp, the activity of single units in the FDP allows for a relatively selective control of forces at the tips of the index, middle and ring fingers, but this is limited for little-finger units. PMID:12181299

  20. Biomechanical testing of a novel tendon implant device for the repair of equine flexor tendon lacerations.

    PubMed

    Barrett, Elizabeth J; Munsterman, Amelia S; Hanson, R Reid; Jackson, Robert L

    2014-08-01

    To compare in vitro strength and failure characteristics of a tendon implant against a 3 loop pulley suture pattern for equine superficial digital flexor tendon (SDFT) laceration repair. Experimental. Cadaveric equine forelimb SDFT (n = 16). One tendon of each of 8 pair of SDFT was randomly selected for repair with either the 3-loop pulley (3LP) suture pattern using 2 polydioxanone or with 4 stainless steel suture and anchor implants (SA). Ultimate load to failure, mode of failure, gap at failure, and load to 2 mm gap were obtained using a materials testing system synchronized with a high-speed camera. Statistical evaluation was made using Student's t-test; significance was set at P ≤ .05. The 3LP failed at a significantly (P = .0001) greater load (363.5 ± 83.7 N) than SA (132.4 ± 26.8 N), but the load to a 2 mm gap (3LP = 164.9 ± 67.7 N, SA = 114.5 ± 21.5 N) was not significantly different (P = .09). Failure mode was by suture pull out and anchor pull out respectively. The gap at failure was significantly larger in the 3LP than in SA repair (P = .000005). Both the SA repair and the 3LP resisted similar tension to 2 mm gap. However, the ultimate load to failure of the SA repair was only 36% that of the 3LP repair. © Copyright 2014 by The American College of Veterinary Surgeons.

  1. Diffusion of mepivacaine to adjacent synovial structures after intrasynovial analgesia of the digital flexor tendon sheath.

    PubMed

    Jordana, M; Martens, A; Duchateau, L; Haspeslagh, M; Vanderperren, K; Oosterlinck, M; Pille, F

    2016-05-01

    Controversy exists about the specificity of diagnostic analgesia of the digital flexor tendon sheath (DFTS) in horses. To evaluate the degree of diffusion of mepivacaine from the equine DFTS to adjacent synovial structures. Crossover experiment. Under general anaesthesia, the DFTS of one front and one hindlimb of 8 horses were injected simultaneously with mepivacaine. Synovial fluid samples of the injected DFTS, the adjacent metacarpo-/metatarsophalangeal (MCP/MTP) joint, proximal interphalangeal joint, distal interphalangeal joint, navicular bursa and contralateral MCP/MTP joint were collected 15 min post injection (T15) from one of the injected limbs and 60 min post injection (T60) from the other limb. Venous blood samples were obtained at T0, T15 and T60 to evaluate systemic distribution of mepivacaine. After a 2-week washout period, the procedure was repeated using the same limbs but reversing the time of sampling (front vs. hindlimbs). The concentration of mepivacaine in samples was measured with a commercial ELISA kit. Mepivacaine concentrations in the DFTS samples, at both T15 (5077 mg/l) and T60 (3503 mg/l), exceeded those estimated sufficient to produce synovial analgesia (100 mg/l or 300 mg/l). Mepivacaine was found in all synovial structures adjacent to the injected DFTS and in the contralateral MCP/MTP joints, but concentrations were low, with a maximum value of only 3.2 mg/l. With the exception of the navicular bursa samples, the mepivacaine concentrations in the adjacent synovial structures were significantly higher at T60 than at T15 (P<0.03). Significantly higher mepivacaine concentrations were found in the ipsilateral than the contralateral MCP/MTP joints at T60 (P<0.001). Blood samples had significantly higher mepivacaine concentrations at T15 and T60 than at T0 (P<0.001). Mepivacaine injected into the DFTS of horses diffuses towards adjacent synovial structures without achieving clinically relevant concentrations. © 2015 EVJ Ltd.

  2. Effects of Neuromuscular Electrical Stimulation and Resistance Training on Knee Extensor/Flexor Muscles.

    PubMed

    Pantović, Milan; Popović, Boris; Madić, Dejan; Obradović, Jelena

    2015-07-01

    Neuromuscular electrical stimulation (NMES) has recently drawn a lot of attention as means for strengthening of voluntary muscle contraction both in sport and rehabilitation. NMES training increases maximal voluntary contraction (MVC) force output through neural adaptations. On the other hand, positive effects of resistance training (RT) on muscle strength are well known. The aim of this study was to investigate effects of a 5-week program of NMES compared to RT program of same duration. Sample of 15 students' of faculty of sport and physical education (age 22 ± 2) were randomized in two groups: NMES (N = 7) and RT (N = 8). NMES group performed NMES superimposed over voluntary muscle contraction, RT group performed resistance training with submaximal loads. Subjects were evaluated for knee isokinetic dynamometry on both sides (60° and 180° s). After intervention no significant difference between groups were observed in isokinetic dynamometry (p = 0.177). However, applying pair sample t test within each group revealed that peak torque increased in NMES-group (p = 0.002 for right knee extensors muscles, p = 0.003 for left, respectively, at 60° and p = 0.004 for left knee extensors muscles, at angular velocity 180°). In RT group (p = 0.033 for right knee extensors muscles, p = 0.029 for right knee flexor muscles, at angular velocity 60°). Our results indicate that NMES has equal potential if not in some way better than classical RT having in mind that overload on locomotor apparatus during NMES is minimal and force of muscle contraction is equal on both sides, for enhancement of knee muscles concentric peak torque.

  3. Maximal force, voluntary activation and muscle soreness after eccentric damage to human elbow flexor muscles

    PubMed Central

    Prasartwuth, O; Taylor, JL; Gandevia, SC

    2005-01-01

    Muscle damage reduces voluntary force after eccentric exercise but impaired neural drive to the muscle may also contribute. To determine whether the delayed-onset muscle soreness, which develops ∼1 day after exercise, reduces voluntary activation and to identify the possible site for any reduction, voluntary activation of elbow flexor muscles was examined with both motor cortex and motor nerve stimulation. We measured maximal voluntary isometric torque (MVC), twitch torque, muscle soreness and voluntary activation in eight subjects before, immediately after, 2 h after, 1, 2, 4 and 8 days after eccentric exercise. Motor nerve stimulation and motor cortex stimulation were used to derive twitch torques and measures of voluntary activation. Eccentric exercise immediately reduced the MVC by 38 ± 3% (mean ±s.d., n = 8). The resting twitch produced by motor nerve stimulation fell by 82 ± 6%, and the estimated resting twitch by cortical stimulation fell by 47 ± 15%. While voluntary torque recovered after 8 days, both measures of the resting twitch remained depressed. Muscle tenderness occurred 1–2 days after exercise, and pain during contractions on days 1–4, but changes in voluntary activation did not follow this time course. Voluntary activation assessed with nerve stimulation fell 19 ± 6% immediately after exercise but was not different from control values after 2 days. Voluntary activation assessed by motor cortex stimulation was unchanged by eccentric exercise. During MVCs, absolute increments in torque evoked by nerve and cortical stimulation behaved differently. Those to cortical stimulation decreased whereas those to nerve stimulation tended to increase. These findings suggest that reduced voluntary activation contributes to the early force loss after eccentric exercise, but that it is not due to muscle soreness. The impairment of voluntary activation to nerve stimulation but not motor cortical stimulation suggests that the activation deficit lies in the

  4. The effect of knee joint angle on plantar flexor power in young and old men.

    PubMed

    Dalton, Brian H; Allen, Matti D; Power, Geoffrey A; Vandervoort, Anthony A; Rice, Charles L

    2014-04-01

    Human adult aging is associated with a loss of strength, contractile velocity and hence, power. The principal plantar flexors, consisting of the bi-articular gastrocnemeii and the mono-articular soleus, appear to be affected differently by the aging process. However, the age-related effect of knee joint angle on the torque-angular velocity relationship and power production of this functionally important muscle group is unknown. The purpose was to determine whether flexing the knee, thereby reducing the gastrocnemius contribution to plantar flexion, would exacerbate the age-related decrements in plantar flexion power, or shift the torque-angular velocity relationship differently in older compared with young men. Neuromuscular properties were recorded from 10 young (~25 y) and 10 old (~78 y) men with the knee extended (170°) and flexed (90°), in a randomized order. Participants performed maximal voluntary isometric contractions (MVCs), followed by maximal velocity-dependent shortening contractions at pre-set loads, ranging from 15 to 75% MVC. The young men were ~20-25% stronger, ~12% faster and ~30% more powerful than the old for both knee angles (P<0.05). In both age groups, isometric MVC torque was ~17% greater in the extended than flexed knee position, with no differences in voluntary activation (>95%). The young men produced 7-12% faster angular velocities in the extended knee position for loads ≤30% MVC, but no differences at higher loads; whereas there were no detectable differences in angular velocity between knee positions in the old across all relative loads. For both knee angles, young men produced peak power at 43.3±9.0% MVC, whereas the old men produced peak power at 54.8±7.9% MVC. These data indicate that the young, who have faster contracting muscles compared with the old, can rely more on velocity than torque for generating maximal power. Copyright © 2014. Published by Elsevier Inc.

  5. Age and sex differences in steadiness of elbow flexor muscles with imposed cognitive demand.

    PubMed

    Pereira, Hugo M; Spears, Vincent C; Schlinder-Delap, Bonnie; Yoon, Tejin; Nielson, Kristy A; Hunter, Sandra K

    2015-06-01

    These studies determined (1) age- and sex-related differences in steadiness of isometric contractions when high cognitive demand was imposed across a range of forces with the elbow flexor muscles (study 1) and; (2) sex differences in steadiness among older adults when low cognitive demand was imposed (study 2). 36 young adults (18-25 years; 18 women) and 30 older adults (60-82 years; 17 women) performed isometric contractions at 5, 30 and 40 % of maximum voluntary contraction (MVC). Study 1 involved a high-cognitive demand session (serial subtractions by 13 during the contraction) and a control session (no mental math). Study 2 (older adults only) involved a low-cognitive demand session (subtracting by 1s). Older individuals exhibited greater increases in force fluctuations (coefficient of variation of force, CV) with high cognitive demand than young adults, with the largest age difference at 5 % MVC (P = 0.01). Older adults had greater agonist EMG activity with high-cognitive demand and women had greater coactivation than men (P < 0.05). In study 2, CV of force increased with low cognitive demand for the older women but not for the older men (P = 0.03). Older adults had reduced steadiness and increased muscle activation when high cognitive demand was imposed while low cognitive demand induced increased force fluctuations in older women but not older men. These findings have implications for daily and work-related tasks that involve cognitive demand performed simultaneously during submaximal isometric contractions in an aging workforce.

  6. The role of the flexor carpi radialis muscle in scapholunate instability.

    PubMed

    Salvà-Coll, G; Garcia-Elias, M; Llusá-Pérez, M; Rodríguez-Baeza, A

    2011-01-01

    The flexor carpi radialis (FCR) muscle has been suggested to act as a dynamic scaphoid stabilizer. Because the FCR tendon uses the scaphoid tuberosity as a pulley to reach its distal insertion onto the second metacarpal, it has been hypothesized that FCR muscle contraction generates a dorsally directed vector that resists the scaphoid from rotating into flexion. The purpose of the present study was to validate that hypothesis and clarify the role of the FCR as a dynamic scaphoid stabilizer. Ten fresh cadaver wrist specimens were tested. A custom-designed testing apparatus was used to hold the forearm and wrist vertically, in neutral forearm rotation. A 6-degree-of-freedom, electromagnetic motion-tracking device, with sensors attached to the scaphoid, triquetrum, capitate, and radius, was used to monitor spatial changes in carpal alignment as a result of isometrically loading the FCR in 5 different wrist positions. In all specimens and all wrist positions, the scaphoid consistently rotated into flexion when the FCR was loaded. It also exhibited variable degrees of pronation or supination, depending on whether the wrist was in flexion or extension. When the wrist was loaded in neutral position, the scaphoid consistently supinated and the triquetrum pronated, these differences being statistically significant (p < .05). The scaphoid consistently rotated into flexion and supination when the FCR was loaded, while the triquetrum rotated in flexion and pronation. The positive effects of FCR muscle re-education in dynamic scapholunate instabilities can be explained not by this muscle's capability of extending the scaphoid, as has often been hypothesized, but by its ability to induce supination to the scaphoid and pronation to the triquetrum. Such opposite rotations are likely to result in a dorsal coaptation of the scapholunate joint with relaxation of the dorsal scapholunate ligament. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc

  7. Low-intensity eccentric contractions of the knee extensors and flexors protect against muscle damage.

    PubMed

    Lin, Min-Ju; Chen, Trevor Chung-Ching; Chen, Hsin-Lian; Wu, Bo-Han; Nosaka, Kazunori

    2015-10-01

    This study investigated the magnitude and duration of the protective effect of low-intensity eccentric contractions (LowEC) against damage induced by maximal eccentric contractions (MaxEC) of the knee flexors (KF) and extensors (KE). Young men were assigned to 8 experimental groups and 2 control groups (n = 13/group); the experimental groups performed LowEC of KF or KE 2 days (2d), 1 week (1wk), 2 weeks (2wk), or 3 weeks (3wk) before MaxEC, while the control groups performed MaxEC of KF or KE without LowEC. The 2d, 1wk, 2wk, and 3wk groups performed 30 LowEC of KF or 60 LowEC of KE with a load of 10% of maximal voluntary isometric contraction strength on a resistance-training machine, and all groups performed 30 MaxEC of KF or 60 MaxEC of KE on an isokinetic dynamometer. Several muscle damage markers were measured from before to 2 days after exercise (LowEC) or from before to 5 days after exercise (MaxEC). No significant changes in any variables were evident after LowEC. The changes in all variables after MaxEC were smaller (P < 0.05) for the 2d and 1wk groups (e.g., peak creatine kinase activity: 1002 ± 501 IU/L; peak muscle soreness: 13 ± 5 mm) than for the control group (peak creatine kinase activity: 3005 ± 983 IU/L; peak muscle soreness 28 ± 6 mm) for both KE and KF. There were no significant differences between the 2d and 1wk groups or among the 2wk, 3wk, and control groups. These results show that LowEC provided 30%-66% protection against damage induced by MaxEC of KF and KE, and the protective effect lasted 1 week.

  8. Eccentric Plantar-Flexor Torque Deficits in Participants With Functional Ankle Instability

    PubMed Central

    Fox, Jason; Docherty, Carrie L; Schrader, John; Applegate, Trent

    2008-01-01

    Context: Inversion ankle sprains can lead to a chronic condition called functional ankle instability (FAI). Limited research has been reported regarding isokinetic measures for the plantar flexors and dorsiflexors of the ankle. Objective: To examine the isokinetic eccentric torque measures of the ankle musculature in participants with stable ankles and participants with functionally unstable ankles during inversion, eversion, plantar flexion, and dorsiflexion. Design: Case-control study. Setting: Athletic training research laboratory. Patients or Other Participants: Twenty participants with a history of “giving way” were included in the FAI group. Inclusion criteria for the FAI group included a history of at least 1 ankle sprain and repeated episodes of giving way. Twenty participants with no prior history of ankle injury were included in the control group. Intervention(s): Isokinetic eccentric torque was assessed in each participant. Main Outcome Measure(s): Isokinetic eccentric testing was conducted for inversion-eversion and plantar-flexion–dorsiflexion movements. Peak torque values were standardized to each participant's body weight. The average of the 3 trials for each direction was used for statistical analysis. Results: A significant side-by-group interaction was noted for eccentric plantar flexion torque (P < .01). Follow-up t tests revealed a significant difference between the FAI limb in the FAI group and the matched limb in the control group. Additionally, a significant difference was seen between the sides of the control group (P = .03). No significant interactions were identified for eccentric inversion, eversion, or dorsiflexion torques (P > .05). Conclusions: A deficit in plantar flexion torque was identified in the functionally unstable ankles. No deficits were identified for inversion, eversion, or dorsiflexion torque. Therefore, eccentric plantar flexion strength may be an important contributing factor to functional ankle instability. PMID

  9. Comparison of a new multifilament stainless steel suture with frequently used sutures for flexor tendon repair.

    PubMed

    McDonald, Erik; Gordon, Joshua A; Buckley, Jenni M; Gordon, Leonard

    2011-06-01

    To investigate the mechanical properties of some common suture materials currently in use and compare them with a new multifilament stainless steel suture. We investigated the mechanical properties of 3-0 and 4-0 Fiberwire, 3-0 Supramid, 3-0 Ethibond, and a new 3-0 and 4-0 multifilament stainless steel suture. All suture material was tested in a knotted configuration and all but the Supramid was tested in an unknotted configuration. We measured the load, elongation at failure, and stiffness during both tests. The 4-0 multifilament stainless steel showed the least elongation, whereas the 3-0 multifilament stainless steel withstood the highest load of any material in both the knotted and unknotted tests. There was no difference in stiffness between the 3-0 and 4-0 multifilament stainless steel when untied; however, the 3-0 multifilament stainless steel was stiffer when tied. Soaking in a saline solution had no significant effect on the ultimate load, elongation at failure, or stiffness of any of the sutures. The 3-0 Fiberwire and 3-0 Ethibond required at least 5 throws to resist untying. Multifilament stainless steel exhibited promising mechanical advantages over the other sutures tested. More research is needed to determine how this material will affect the clinical outcomes of primary flexor tendon repair. With a secure attachment to the tendon, the multifilament stainless steel's lower elongation and better knot-holding ability may result in a higher force to produce a 2-mm gap and a higher ultimate tensile strength in a tendon repair. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  10. Age and sex differences in steadiness of elbow flexor muscles with imposed cognitive demand

    PubMed Central

    Pereira, Hugo M.; Spears, Vincent C.; Schlinder-Delap, Bonnie; Yoon, Tejin; Nielson, Kristy A.; Hunter, Sandra K.

    2015-01-01

    Purpose These studies determined (1) age and sex-related differences in steadiness of isometric contractions when high cognitive demand was imposed across a range of forces with the elbow flexor muscles (study 1) and, (2) sex differences in steadiness among older adults when low cognitive demand was imposed (study 2). Methods 36 young adults (18–25 years; 18 women) and 30 older adults (60–82 years; 17 women) performed isometric contractions at 5%, 30% and 40% of maximum voluntary contraction (MVC). Study 1 involved a high-cognitive demand session (serial subtractions by 13 during the contraction) and a control session (no mental math). Study 2 (older adults only) involved a low-cognitive demand session (subtracting by 1s). Results Older individuals exhibited greater increases in force fluctuations (coefficient of variation of force, CV) with high cognitive demand than young adults, with the largest age difference at 5% MVC (P = 0.01). Older adults had greater agonist EMG activity with high-cognitive demand and women had greater coactivation than men (P<0.05). In study 2, CV of force increased with low cognitive demand for the older women but not for the older men (P = 0.03). Conclusion Older adults had reduced steadiness and increased muscle activation when high cognitive demand was imposed while low cognitive demand induced increased force fluctuations in older women but not older men. These findings have implications for daily and work-related tasks that involve cognitive demand performed simultaneously during submaximal isometric contractions in an aging workforce. PMID:25633070

  11. Resection of the flexor digitorum superficialis for trigger finger with proximal interphalangeal joint positional contracture.

    PubMed

    Favre, Yann; Kinnen, Louis

    2012-11-01

    Open release of the A1 pulley is a widely known procedure for the treatment of trigger finger. A subset of patients presents with both trigger finger and a positional contracture of the proximal interphalangeal (PIP) joint. These patients usually have a long history of trigger finger or have already undergone a surgical release of the annular pulley. This study is a retrospective review of the outcomes of resection of the flexor digitorum superficialis (FDS) for patients whose trigger finger was associated with a positional contracture of the PIP joint. Thirty-six patients (39 fingers) were treated by resection of the FDS after section of the A1 pulley. The mean age of the patients was 63 years (range, 45-90 y). Seven patients (19 %) had previously undergone an open release of the A1 pulley and had developed a positional contracture of the PIP joint 2 to 5 months afterward. We performed a retrospective review with a mean follow-up of 30 months (range, 12-60 mo). No patient was lost to follow-up. The active range of motion was recorded at the PIP joint before and after surgery. The mean preoperative positional contracture of the PIP joint was 24° (range, 15°-30°). The mean postoperative positional contracture of the PIP joint was 4° (range, 0°-10°). The most commonly affected digit was the middle finger (26 fingers, 67%). In 28 fingers (72%), full extension was achieved following only the surgical procedure. The remaining 11 fingers (28%) had a postoperative residual positional contracture (range, 5°-10°). However, all fingers achieved a full range of motion after physical therapy and an injection of betamethasone. All of the resected tendons had histological damage. This technique is a useful treatment for selected patients whose trigger finger is associated with a positional contracture. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Eccentric plantar-flexor torque deficits in participants with functional ankle instability.

    PubMed

    Fox, Jason; Docherty, Carrie L; Schrader, John; Applegate, Trent

    2008-01-01

    Inversion ankle sprains can lead to a chronic condition called functional ankle instability (FAI). Limited research has been reported regarding isokinetic measures for the plantar flexors and dorsiflexors of the ankle. To examine the isokinetic eccentric torque measures of the ankle musculature in participants with stable ankles and participants with functionally unstable ankles during inversion, eversion, plantar flexion, and dorsiflexion. Case-control study. Athletic training research laboratory. Twenty participants with a history of "giving way" were included in the FAI group. Inclusion criteria for the FAI group included a history of at least 1 ankle sprain and repeated episodes of giving way. Twenty participants with no prior history of ankle injury were included in the control group. Isokinetic eccentric torque was assessed in each participant. Isokinetic eccentric testing was conducted for inversion-eversion and plantar-flexion-dorsiflexion movements. Peak torque values were standardized to each participant's body weight. The average of the 3 trials for each direction was used for statistical analysis. A significant side-by-group interaction was noted for eccentric plantar flexion torque (P < .01). Follow-up t tests revealed a significant difference between the FAI limb in the FAI group and the matched limb in the control group. Additionally, a significant difference was seen between the sides of the control group (P = .03). No significant interactions were identified for eccentric inversion, eversion, or dorsiflexion torques (P > .05). A deficit in plantar flexion torque was identified in the functionally unstable ankles. No deficits were identified for inversion, eversion, or dorsiflexion torque. Therefore, eccentric plantar flexion strength may be an important contributing factor to functional ankle instability.

  13. Maximal force, voluntary activation and muscle soreness after eccentric damage to human elbow flexor muscles.

    PubMed

    Prasartwuth, O; Taylor, J L; Gandevia, S C

    2005-08-15

    Muscle damage reduces voluntary force after eccentric exercise but impaired neural drive to the muscle may also contribute. To determine whether the delayed-onset muscle soreness, which develops approximately 1 day after exercise, reduces voluntary activation and to identify the possible site for any reduction, voluntary activation of elbow flexor muscles was examined with both motor cortex and motor nerve stimulation. We measured maximal voluntary isometric torque (MVC), twitch torque, muscle soreness and voluntary activation in eight subjects before, immediately after, 2 h after, 1, 2, 4 and 8 days after eccentric exercise. Motor nerve stimulation and motor cortex stimulation were used to derive twitch torques and measures of voluntary activation. Eccentric exercise immediately reduced the MVC by 38 +/- 3% (mean +/- s.d., n = 8). The resting twitch produced by motor nerve stimulation fell by 82 +/- 6%, and the estimated resting twitch by cortical stimulation fell by 47 +/- 15%. While voluntary torque recovered after 8 days, both measures of the resting twitch remained depressed. Muscle tenderness occurred 1-2 days after exercise, and pain during contractions on days 1-4, but changes in voluntary activation did not follow this time course. Voluntary activation assessed with nerve stimulation fell 19 +/- 6% immediately after exercise but was not different from control values after 2 days. Voluntary activation assessed by motor cortex stimulation was unchanged by eccentric exercise. During MVCs, absolute increments in torque evoked by nerve and cortical stimulation behaved differently. Those to cortical stimulation decreased whereas those to nerve stimulation tended to increase. These findings suggest that reduced voluntary activation contributes to the early force loss after eccentric exercise, but that it is not due to muscle soreness. The impairment of voluntary activation to nerve stimulation but not motor cortical stimulation suggests that the activation

  14. Central hyperexcitability as measured with nociceptive flexor reflex threshold in chronic musculoskeletal pain: a systematic review.

    PubMed

    Lim, Edwin Choon Wyn; Sterling, Michele; Stone, Andrew; Vicenzino, Bill

    2011-08-01

    Chronic musculoskeletal conditions are increasingly conceived as involving altered central nervous system processing, and impaired nociceptive flexor reflex (NFR) appears to reflect altered central nervous system processing. The primary objective was to synthesize the evidence for impaired NFR in these conditions. The secondary objective was to evaluate the NFR stimuli parameters employed by reviewed studies. Electronic databases: MEDLINE, CINAHL, Embase, PEDro, Google Scholar, and Cochrane library were searched from the mid-1960s to June 2010. Experimental reports were systematically reviewed and meta-analysis (where possible) was performed. NFR thresholds and parameters of NFR stimuli were extracted. Sixteen trials were identified, 11 of which were suitable for inclusion in the meta-analysis. Compared to healthy controls, standardized mean differences in NFR threshold were significantly lower in subjects with primary headache (-0.45; 95% confidence interval [CI] -0.77 to -0.13, P=0.005), fibromyalgia (-0.63; 95% CI -0.93 to -0.34, P<0.0001), knee pain (-1.51; 95% CI -2.10 to -0.93, P<0.00001) and whiplash (-0.73; 95% CI -1.11 to -0.35, P=0.0002). Employed stimuli parameters vary between studies, with inter-pulse duration (P=0.044) being identified by multiple regression analysis as independent predictors of the variability in NFR threshold in healthy controls. The results indicate that there is evidence of central hyperexcitability in people with chronic musculoskeletal pain. Our review also suggests that shorter inter-pulse duration tends to yield smaller variability in NFR threshold. However, further research investigating optimal stimulation parameters is still warranted.

  15. Do somatosensory conditions from the foot and ankle affect postural responses to plantar-flexor muscles fatigue during bipedal quiet stance?

    PubMed

    Hlavackova, Petra; Vuillerme, Nicolas

    2012-05-01

    The present study investigated the effects of somatosensory conditions at the foot and ankle on postural responses to plantar-flexor muscle fatigue during bipedal quiet stance. Twenty-two young healthy adults were asked to stand upright as still as possible with their eyes closed in three somatosensory conditions (normal, altered and improved) both prior to and after exercises inducing plantar-flexor muscle fatigue. In the normal condition, the postural task was executed on a firm support surface constituted by the force platform. In the altered condition, a 2-cm thick foam support surface was placed under the subjects' feet. In the improved condition, increased cutaneous feedback at the foot and ankle was provided by strips of athletic tape applied across both their ankle joints. Muscle fatigue was induced in the plantar-flexor muscles of both legs through the execution of a repeated standing heel raise exercise. Centre of foot pressure displacements were recorded using a force platform. Results showed that plantar-flexor muscle fatigue yielded increased centre of foot pressure displacements under normal foot and ankle sensory conditions. Furthermore, this effect was exacerbated under altered foot and ankle sensory conditions and mitigated under improved foot and ankle sensory conditions. Altogether, the present findings suggested an increased reliance on somatosensory information from the foot and ankle for controlling upright posture in the presence of plantar-flexor muscle fatigue.

  16. Relationships of ultrasound measures of intrinsic foot muscle cross-sectional area and muscle volume with maximum toe flexor muscle strength and physical performance in young adults

    PubMed Central

    Abe, Takashi; Tayashiki, Kota; Nakatani, Miyuki; Watanabe, Hironori

    2016-01-01

    [Purpose] To investigate the relationships between toe flexor muscle strength with (TFS-5-toes) and without (TFS-4-toes) the contribution of the great toe, anatomical and physiological muscle cross-sectional areas (CSA) of intrinsic toe flexor muscle and physical performance were measured. [Subjects] Seventeen men (82% sports-active) and 17 women (47% sports-active), aged 20 to 35 years, volunteered. [Methods] Anatomical CSA was measured in two intrinsic toe flexor muscles (flexor digitorum brevis [FDB] and abductor hallucis) by ultrasound. Muscle volume and muscle length of the FDB were also estimated, and physiological CSA was calculated. [Results] Both TFS-5-toes and TFS-4-toes correlated positively with walking speed in men (r=0.584 and r=0.553, respectively) and women (r=0.748 and r=0.533, respectively). Physiological CSA of the FDB was significantly correlated with TFS-5-toes (r=0.748) and TFS-4-toes (r=0.573) in women. In men, physiological CSA of the FDB correlated positively with TFS-4-toes (r=0.536), but not with TFS-5-toes (r=0.333). [Conclusion] Our results indicate that physiological CSA of the FDB is moderately associated with TFS-4-toes while toe flexor strength correlates with walking performance. PMID:26957721

  17. Dynamic stability of the elbow: electromyographic analysis of the flexor pronator group and the extensor group in pitchers with valgus instability.

    PubMed

    Hamilton, C D; Glousman, R E; Jobe, F W; Brault, J; Pink, M; Perry, J

    1996-01-01

    The medical collateral ligament is a common site of injury in baseball pitchers, causing substantial morbidity and loss of pitching time. Twenty-six skilled baseball pitchers with medial collateral ligament insufficiency were studied before surgery with high-speed cinematography and fine-wire electromyography of eight muscles around the elbow. Data from the pitchers with injured elbows were compared with data obtained from uninjured pitchers. The flexor carpi radialis muscle in the pitchers with medial collateral ligament deficiencies revealed significantly decreased firing during the acceleration and deceleration phase of the fastball when compared with that of the pitchers with normal elbows, and the flexor carpi radialis muscle was significantly depressed during the early cocking and deceleration phases. The extensor muscles revealed slightly increased activity in the injured elbows; however, this was not statistically significant. Although the muscles of the flexor pronator group (especially the flexor carpi ulnaris muscle and the flexor digitorum superficialis muscles) are anatomically positioned to provide dynamic stability of the elbow, they did not demonstrate increased electrical activity in pitchers with medial collateral ligament deficiencies. This finding suggests that the muscles on the medial side of the elbow do not supplant the role of the medial collateral ligament during the fastball pitch.

  18. Combined flexor hallucis longus tendon transfer and gastrocnemius recession for reconstruction of gapped chronic achilles tendon ruptures.

    PubMed

    Elgohary, Hatem Elsayed Ahmed; Elmoghazy, Nabil A; Abd Ellatif, Mohammed Serry

    2016-12-01

    The aim of this study was to assess the functional outcomes after a combined FHL transfer and a gastrocnemius recession for treatment of chronic ruptures of Achilles tendon with a gap and to investigate the patient's satisfaction about the great toe function after transfer. 19 patients with chronic rupture of the Achilles tendon with a gap were treated with a flexor halluces longus tendon transfer combined with a gastrocnemius recession, Clinical diagnosis depends on the presence of gap in the tendon on examination, inability of tip toe walking on the affected side and positive calf-squeeze test, MRI was used to confirm the clinical diagnosis. American Orthopedic Foot & Ankle Society hind foot score was used for assessment of the results. The AOFAS score improved significantly from a mean of 65 preoperatively to 94 at the last follow up (p<0.001), there was no significant difference in the final outcome between patients with FHL tendon weaved through the stump of the Achilles tendon and those with trans osseous tunnels, the mean AOFAS score at the last follow up was 94.2, 93.8 respectively, no patient complained of big toe dysfunction. Management of chronic rupture of the Achilles tendon with a gap with flexor halluces longus tendon transfer combined with a gastrocnemius recession is a safe and reliable method with a significantly improved functional outcome, muscle advancement through gastrocnemius recession decreases the length of the gap without affecting the muscle function, flexor halluces longus tendon transfer doesn't harm the big toe function. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Evaluation of physiological standard pressures of the forearm flexor muscles during sport specific ergometry in sport climbers

    PubMed Central

    Schoeffl, V; Klee, S; Strecker, W

    2004-01-01

    Background: Chronic exertional compartment syndromes (CECS) are well known in sports medicine. Most commonly affected is the tibialis anterior muscle compartment in runners and walkers. Only a few cases of CECS of the forearm flexor muscles have been reported. Objectives: To determine pressure levels inside the deep flexor compartment of the forearms during a sport specific stress test. Method: Ten healthy, high level climbers were enrolled in a prospective study. All underwent climbing specific ergometry, using a rotating climbing wall (step test, total climbing time 9–15 minutes). Pressure was measured using a slit catheter placed in the deep flexor compartment of the forearm. Pressure, blood lactate, and heart rate were recorded every three minutes and during recovery. Results: In all the subjects, physical exhaustion of the forearms defined the end point of the climbing ergometry. Blood lactate increased with physical stress, reaching a mean of 3.48 mmol/l. Compartment pressure was related to physical stress, exceeding 30 mm Hg in only three subjects. A critical pressure of more than 40 mm Hg was never observed. After the test, the pressure decreased to normal levels within three minutes in seven subjects. The three with higher pressure levels (>30 mm Hg) required a longer time to recover. Conclusions: For further clinical and therapeutic consequences, an algorithm was derived. Basic pressure below 15 mm Hg and stress pressure below 30 mm Hg as well as pressures during the 15 minute recovery period below 15 mm Hg are physiological. Pressures of 15–30 mm Hg during recovery suggest high risk of CECS, and pressures above 30 mm Hg confirm CECS. PMID:15273176

  20. Effect of an eccentrically biased hamstring strengthening home program on knee flexor strength and the length-tension relationship.

    PubMed

    Orishimo, Karl F; McHugh, Malachy P

    2015-03-01

    The purposes of this study were to document relative activation intensities of the hamstrings and gluteus maximus during 4 eccentric hamstring strengthening exercises and to assess the effects of a short-term strengthening program comprised of these exercises on knee flexor strength and the length-tension relationship. Twelve healthy subjects participated in this study. Electromyographic (EMG) activities from the biceps femoris, semitendinosus, and gluteus maximus were recorded as subjects performed (a) standing hip extension with elastic resistance, (b) trunk flexion in single limb stance (diver), (c) standing split (glider), and (d) supine sliding bridge (slider). Baseline isometric knee flexor strength was measured at 90, 70, 50, and 30° of flexion at the knee with the subject seated and the hip flexed to 50° from horizontal. After completing the 4-week training program, strength tests were repeated. Repeated-measures analysis of variance were used to compare EMG activity between muscles and to assess angle-specific strength improvements. Hamstring activity exceeded gluteus maximus activity for resisted hip extension, glider, and slider exercises (p < 0.001) but not for the diver (p = 0.087). Hamstring activation was greatest during the slider and resisted hip extension and lowest during the glider and the diver. Knee flexor strength improved by 9.0% (p = 0.005) but was not angle specific (training by angle p = 0.874). The short-term home training program effectively targeted the hamstrings and resulted in strength gains that were similar at short and long muscle lengths. These data demonstrate that hamstring strength can be improved using eccentrically biased unilateral exercises without the use of weights or other equipments.

  1. Assessing Finger Joint Biomechanics by Applying Equal Force to Flexor Tendons In Vitro Using a Novel Simultaneous Approach

    PubMed Central

    Yang, Tai-Hua; Lu, Szu-Ching; Lin, Wei-Jr; Zhao, Kristin; Zhao, Chunfeng; An, Kai-Nan; Jou, I-Ming; Lee, Pei-Yuan

    2016-01-01

    Background The flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) are critical for finger flexion. Although research has recently focused on these tendons’ coactivity, their contributions in different tasks remain unclear. This study created a novel simultaneous approach to investigate the coactivity between the tendons and to clarify their contributions in different tasks. Methods Ten human cadaveric hands were mounted on our custom frame with the FDS and FDP of the third finger looped through a mechanical pulley connected to a force transducer. Joint range of motion, tendon excursion and loading force were recorded during individual joint motion and free joint movement from rest to maximal flexion. Each flexor tendon’s moment arm was then calculated. Results In individual motions, we found that the FDP contributed more than the FDS in proximal interphalangeal (PIP) joint motion, with an overall slope of 1.34 and all FDP-to-FDS excursion (P/S) ratios